If alternative treatment with decent prognosis exists (in this case Hemodialysis is such an option), to get past the ethics committee, first operations like these typically have to be done on patients on their death bed. That doesn’t make it likely the patients survive a long time.
For example, here’s what Wikipedia says this of the first receiver of a heart transplant (https://en.wikipedia.org/wiki/Louis_Washkansky):
“As a result of heart attacks in 1965, approximately only one third of his heart was still functioning. In late October, he went into a diabetic coma, but regained consciousness. Once, when he was swollen with fluid and in considerable pain, his wife Ann asked him in a whisper how he was doing. He managed a smile and whispered, "I'm on top of the world." He was also suffering from kidney and liver failure.”
And that’s a case where no good alternative treatment existed, at a time when ethics committees weren’t as stringent as they are today, if they existed at all.