Many medical conditions in cats are identical to those we humans can experience. Kidney failure is one of them. And in the U.S., there are three main facilities that can provide kidney transplants to cats who need them.

I spoke with the founder of one of them, Dr. Lillian Aronson. She’s the coordinator of the Renal Transplant Program at the University of Pennsylvania School of Veterinary Medicine.

“What I do for my pets mirrors human transplantation in many ways,” she said. “We aren’t a research facility. We see real, clinical patients, cats who are very sick and in kidney failure. And what these cats are going through, it really mirrors what humans go through in the same situation.”

“The main difference,” she goes on to say, “is in scale. Everything is small. Really small. Take the renal artery that goes to the kidney, for instance. In a human it’s around 7 millimeters. In a cat, it’s 1 to 2 mm.” That’s just slightly larger than a really thick pencil lead!

And the ureter? Less than half a millimeter. That’s the width of one of those mechanical pencils I refuse to use because the lead is so thin it snaps every time I push down to write. Aronson explained that a cat’s measurements are 6-7 times smaller than a human’s.

As you can imagine, size is one reason the procedure is so complex. That complexity is also why so few veterinarians specialize in kidney transplants.

Another reason may lie in the fact that it’s not just an in-and-out procedure. For Aronson, it encompasses the lifetime of the pet. “You have to have a passion for the patients, because it’s not just surgery, it’s before and after as well. And it’s not just following the patient. You’re following the donor for the rest of its life, too.”

That’s right. Every cat who receives a kidney gets it from a donor cat. And that donor is, in a way, one very lucky kitty. A non-negotiable requirement is that the donor be rescued from a shelter and adopted by the pet parents of the cat receiving the transplant.

One thing I found interesting: When you transplant a kidney, you typically leave the old one in and install a third one. “I like to say there are the same number of kidneys in the household,” says Aronson. “they’re just redistributed.”

That’s not unusual. It, too, mirrors what goes on in humans. That’s because (at least in humans) the kidney is in a relatively inaccessible area and the risk and increased recovery time aren’t worth it. There’s no harm in leaving the kidney in either. It’s not dead, it’s just not functioning well, so no worries of necrosis (dead tissue).

Post-op, there are actually a few benefits to being a cat over a human. In humans, one of the side effects is often increased cholesterol. While you might see this in a cat’s blood work, it doesn’t present as a clinical problem as it might in a human. Score one for the felines!

But what about life expectancy?

The average age for a kidney transplant is eight years, across 150 cases. The majority of these — as many as 80 percent — were at stage 4 in the disease, meaning without the transplant their life expectancy was measured in months. Post transplant, the average increased to three years, with the longest living an additional 13 years.

And despite what you might think, given anecdotal tales of kidney rejection, it’s not kidney disease that is the culprit. If a cat makes it through the first six months to a year without a rejection episode or any other issues, then they are usually set.

The biggest concern transplant patients must deal with for the rest of their lives is a condition not too dissimilar to that of a cat who has FIV. “The majority of patients by far,” Aronson tells me, “do not die of kidney failure. It’s through complications with immunodeficiency.” And this is a result of the medical regimen every transplant cat must be on daily for the rest of his life: antirejection medications that necessarily must suppress the immune system.

For the pet owner, this means two oral medications daily. But this replaces the numerous drugs a cat has to be on prior to surgery to manage chronic kidney failure. And, again like humans, there are similar long-term effects: risks of diabetes, increased risk of infection, and cancer.

If all this sounds expensive, well, it is.

For everything that’s done — from initial examinations and pre-op workup, through intensive care and two weeks’ stay in hospital for two cats — the total is around $15,000. “For everything that’s done,” says Aronson, “that’s actually pretty reasonable.” Consider, she points out, that one G.I. surgical emergency (like your dog eating your underwear) you can rack up a $6,000 bill in just two days. It’s all a matter of perspective. And priorities.

“The majority of our clients are people who — this is what they save their money for,” she explains. “I’ve had pet parents who tell me, ‘I don’t drink or smoke or go out very often, and this is what I choose to spend my money on.’”

And if you have a younger cat in a lower stage of kidney disease, the amount you may spend managing it chronically over the cat’s lifetime may not quite equal what you spend here, but it may be closer than you think.

“It’s all about focus,” Aronson adds. “I had one person tell me, ‘I just spent $17,000 on my roof and I love my cat a lot more than I do my roof.” While I think most of us would agree with that, still, having a roof over one’s head does rank as kind of important.

An interesting thing happened while researching this article. Laura Bennett, CEO and co-founder of Embrace Pet Insurance, is a friend, so after interviewing Aronson, I contacted her. I wondered if Embrace covered kidney transplants. When she heard I had been researching the procedure, she wanted to hear more.

She was meeting with the company’s underwriters the next day and thought this would be a good procedure to review with them, so I shared the information Aronson had given me. And she, in turn, shared it with them.

“They approved the coverage, and Embrace will be removing that exclusion,” she told me. “It will take some time, probably all of 2016, as we need to file new terms and conditions with every state,” she cautioned, “but it will get done.”

Kidney transplants, now covered by pet insurance? That’s great news!

Would you consider kidney transplant for your cat, factoring in cost, medical management, and a donor for a new feline family member? Would pet insurance coverage make a difference to you? Tell us in the comments!

Read more cool cat science stuff by Lisa Richman:

• 5 Facts You Need to Know About Injection-Site Sarcoma
• Silver Cats May Help Cure Cancer for Humans With Red Hair
• Blindness in Cats Comes From an Unexpected Source

About Lisa Richman: Writer, director, pilot, foodie, cat person. When she’s not on set, this director of film and video can usually be found taking photos of cats (and food) with her trusty Nikon, or cruising aloft at 3,000 feet. She’s cat mom to an opinionated Tonkinese, a hearing-impaired Siamese, and a feline fashionista. She’s also the owner of a recently launched humor blog, and the Cat Writer’s 2014 Entertainment Blog, A Tonk’s Tail.