Answer: A transplant candidate must have end-stage renal failure, be able to withstand at least three hours of surgery under anesthesia and be free of active infections and cancer. In order to tolerate three hours of surgery and anesthesia, age is not a factor, but having a good heart and lungs are. If one is having a transplant, active infections of any kind, HIV, herpeszoster (shingles) whether it be viral, bacterial, fungal or protozoan is an absolute contraindication for transplant candidacy. An active malignancy of any type is an absolute reason to exclude transplant candidacy. The presence of a history of cancer in most instances requires a period of two years of cancer- free status before a transplant can be safely performed. A transplant can be safely performed only when immunosuppressive medications are used. These medications subdue the state of immune responsiveness and therefore when active infection or cancer is present the transplant candidate would die of infection (septicemia) or a metastatic malignancy. Other medical conditions that would make transplant surgery too risky for a transplant candidate would be a severe cardiac disease which results in a cardiac ejection fraction of less than 30 percent, pulmonary hypertension with pulmonary artery pressures of greater than 40 and severe hepatic insufficiency. These conditions are relative contraindications to a single transplant, but would necessitate a double organ transplant in order to save the transplant candidates life. While there are many conditions for which transplantation is rendered high risk, the presence of active infection or active cancer in a patient who cannot withstand transplant surgery are the only absolute contraindications to transplant surgery in 2003. Answer provided by Clive Callender, MD. Dr. Callender is a Professor of Surgery at Howard University Hospital, Washington, DC, and a member of AAKP’s Medical Advisory Board. The Dear Doctor column provides readers with an opportunity to submit renal related health questions to healthcare professionals who specialize in the area of concern. The answers are not to be construed as a diagnosis and therefore, altercations in current healthcare should not occur until the patient's physician is consulted. This article originally appeared in aakpRENALIFE, November 2003 Volume 19 Number 3.
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