Kidney Transplant Process
You must have an evaluation before you will be considered for a transplant. This evaluation process has many steps. It will start with a visit to the transplant clinic. During this visit you will have a physical evaluation, a psychosocial evaluation, and some laboratory tests. At this time, you and your family will attend a transplant information class. Insurance and financial information will also be reviewed with you.
Your responsibilities in getting your evaluation done are to:
- Keep your scheduled appointments.
- Tell the transplant coordinator when you have your tests done or if you cancel an appointment.
- Make sure your test results are sent to your coordinator.
The Physical Evaluation and Laboratory Tests
Testing will be ordered as needed for each person as indicated by his or her age, disease, or medical condition. There are some standard tests that will be required for the majority of individuals. This testing may include:
- Chest x-ray
- ECG (electrocardiogram)
- Renal/abdominal ultrasound
- Gynecologist examination and PAP smear
- Laboratory testing - Serologies, HLA, antibody screening, etc.
During the first transplant clinic visit, the doctor will review your records. The doctor will also examine you and talk to you about your past medical and surgical history. The transplant coordinator will meet with you and talk to you about transplantation. He/she will tell you about other tests that may be needed to finish your evaluation. The coordinator will assist you in getting your testing scheduled.
There are four different blood types. They are A, B, ABO, and O. Every person has one of these blood types. The donor's blood type does not have to be the same. However, it must he "compatible" with your blood type for you to receive the kidney and/or pancreas. The RH factor (+ or -) doesn't affect compatibility.
Viral testing - It is important for us to know if you have been exposed to hepatitis, cytomegalovirus (CMV), Epstein-Barr virus (EBV), or acquired immune deficiency syndrome (AIDS). We will test you for these at your clinic appointment.
Tissue typing - this test is done on white blood cells. The white blood cells have special "markers'' that tell your "tissue type.'' You inherit tissue type from your mother and father. This test is used to help match a kidney and/or pancreas to you.
Panel Reactive Antibody (PRA) - This test shows how active your immune system is. It is easier for you to get a kidney if your immune system is calm or measures 0 percent. PRA samples will have to be drawn on a monthly basis once you are listed. Blood will be drawn at your dialysis center and sent to our laboratory. If you are not on hemodialysis, blood kits will be sent to your home, and you will need to have your blood drawn and sent to the laboratory at LLUMC. You may also come here to have your samples drawn if that is convenient for you.
Cross-match Testing - This test is done when a donor kidney is available. Your blood is mixed with the donor's blood. If there is no reaction (negative cross-match) it means that you are "compatible" with the donor. If there is a reaction (positive cross-match), the kidney will not work for you because it is "incompatible."
Dental Evaluations - You need to have a dental check-up before you will be listed for transplant. Your dentist must tell us that your teeth and gums are healthy. You will also need to be checked by your dentist every year while you are waiting for your transplant.
Vaccinations - There are certain vaccinations that are recommended prior to transplant. These are:
- Diphtheria and tetanus (every 10 years)
- Pneumonia (every 5 years)
- Flu (every year)
- Hepatitis B series vaccine
- PPD skin test (must have)
The Psychosocial Evaluation
The transplant social worker does this. Together you will talk about:
- How kidney failure has changed the way you live
- How you think a transplant will change our life
- Who you can count on for support (family and friends)
- What to do if the use of alcohol, tobacco, and/or drugs has been a part of your life
Support group and family conferences are also a part of the evaluation process. The support group meets twice a month. Besides offering education about transplant, the support group also offers patients a time to meet others who have had similar experiences. You and your family are encouraged to come.
The Financial Evaluation
You will meet with the financial coordinator to talk about your finances, and what your medical insurance covers for your transplant. It would be helpful to have a family member attend this interview with you. Some of the topics that will be discussed are:
- Medicare and other Social Security benefits
- Possible funds to pay for your transplant evaluation
- Possible disability for yourself and/or your live donor
- Fundraising if your insurance does not cover all of your transplant or your medication
- How to handle Medi-Cal eligibility for transplant
- Bills and statements that you receive from the doctors or hospital
- Cost and payment of immunosuppressive medications after transplant