Pediatric Kidney Transplant

Once candidacy for transplant is approved, patients are added to a deceased donor waitlist managed by the United Network for Organ Sharing (UNOS). UNOS gives priority to patients based on waiting time, with retroactive time awarded if dialysis was started before listing. 

Living donation, when possible, is a good alternative to deceased donation. Nearly half of the kidneys transplanted at Mass General are given by living donors. Our program is uniquely equipped to facilitate parent-to-child living kidney donation, with adjacent operating room space and adult and pediatric providers that closely collaborate in your child’s care. 

Learn more about living donor kidney transplant 

Living Kidney Donor Roadmap (PDF)

Kidney failure, or end-stage kidney disease (ESKD), typically happens for different reasons in children than adults. 

The most common causes for pediatric kidney failure are: 

• Birth defects that may result in lack of healthy kidney formation and function, restricted blood flow, or chronic infection 
• Genetic, or inherited, diseases such as polycystic kidney disease 
• Kidney infections, which can sometimes produce an inflammatory response that causes damage to the kidneys 
• Systemic diseases, which affect other organs in the body 
• Kidney trauma or injury that cause a sudden and severe decline in blood flow to the kidneys 

The most common causes of pediatric kidney failure often depend on the child’s age: 

• Birth to age four—kidney birth defects (congenital) and genetic diseases 
• Age five to 14—genetic and systemic diseases 
• Age 15-19—damage to the blood vessels in the kidney (glomeruli)

Diagnosis of pediatric kidney failure is challenging. If the cause is hereditary or congenital, chronic kidney disease may be caught while your baby is in utero. For children, chronic kidney disease often does not cause distinct symptoms. 

If symptoms are present, they may include: 

• Flu-like symptoms, such as fatigue and fever 
• Decline in school performance due to lack of concentration 
• Swelling of the hands, feet, or area around the eyes 
• Change in frequency or color of urination 
• Loss of appetite 
• Headaches due to high blood pressure 
• Stunted growth 

Kidney transplant is the recommended and best treatment for children with end-stage kidney disease. At Mass General for Children, you and your child have access to the latest surgical techniques and a highly specialized, multidisciplinary team—this means that your child has an excellent chance for a much-improved quality of life and long-term survival following transplant surgery versus. 

Dialysis is a therapy for patients with end-stage kidney disease and can keep them alive while they are waiting for kidney transplantation, but not all children require dialysis before getting a kidney transplant. Whether or not a child needs to start dialysis prior to transplant surgery depends on their condition—the length of time they spend on dialysis depends on their age and when a kidney becomes available. 

Your child’s doctor will determine if dialysis is needed or if your child can progress to transplant right away (pre-emptive transplant). 

The length of time that your child awaits transplant depends on how quickly their kidneys are failing and the ability of a donor organ. If your child is receiving a new kidney through living donation, it can be a matter of weeks after the potential donor is approved, and your child’s nephrologist determines that their kidney disease has progressed enough to proceed with transplant. If they are receiving a new kidney through the donor waitlist, it could take longer to find a good quality kidney for your child. Kidney transplant candidates are ranked by wait time, but UNOS prioritizes children for good quality kidneys to help decrease the time that children have to wait.

Donor kidneys come from one of two places: 

• A living donor. In this case, a healthy, living person can choose to donate one of their kidneys to someone with end-stage kidney failure. Donors are able to live normal, healthy lives with their remaining kidney. Learn more about living donor kidney transplant > 
• A deceased donor. Your child may receive a new organ through the donor waitlist. In these cases, the donor is someone who has recently passed away and previously elected to become an organ donor after death. 

A healthy person can choose to donate a kidney to a child they know personally (directed donation) or to a stranger (nondirector or altruistic donation). This is called living donor kidney transplant. Living donation offers many benefits to the child such as reducing wait time, scheduled surgery, and more. 

Do I have to be related to the child to donate my kidney to them?

You do not need to be related to the recipient in order to become a living kidney donor. Becoming a living kidney donor starts with an evaluation to determine compatibility. Our transplant coordinate team will guide you through the process. 

Become a living kidney donor 

Children who undergo kidney transplantation often feel an improvement soon after surgery. Kidney transplant recipients stay in the hospital anywhere from three days to two weeks or more after surgery, depending on their individual recovery speed and the ability of family to take care of the child at home. 

Before going home, your Mass General for Children transplant team will prescribe your child medications to help manage their pain, avoid infection, and prevent kidney rejection. Medication to prevent organ rejection is needed every day, and parents will receive information from our team to help their child manage this important part of their post-transplant care, as well as other important tips for caring for a transplant. 

Your team will inform you how often your child will need to receive check-ups to ensure the transplanted kidney is functioning properly. Typically, frequent check-ups are needed in the year following surgery. However, if there are no complications, the frequency decreases with time.