First, we need to find out if you are a good candidate for transplant. This doesn’t have anything to do with whether you are a good person – we make no judgment about that – it has to do with your physical condition, your body’s ability to go through transplant surgery and accept a new organ.

The initial evaluation includes many tests:

• Physical exam, medical and surgical history
• Social Work assessment
• Electrocardiogram (EKG/ECG)
• Chest X-ray
• Colonoscopy
• Bladder Studies
• Dental Evaluation
• Blood Tests
• Panel Reactive Antibody (PRA)
• Tissue Typing
• Nutrition Assessment
• Mammogram (females)
• Pap-Smear (females)
• Prostrate Specific Antigen (males)

When the transplant committee receives the results of your tests and determines that you are a candidate for transplantation, you may be placed on the waiting list for a new kidney.

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There are many more people waiting for a kidney transplant than there are donated kidneys. A kidney must be compatible to successfully replace your failing kidney. The waiting list for kidneys and other organs is managed by a national organization – the United Network for Organ Sharing (UNOS). Supervised by the federal government, UNOS helps ensure that patients receive healthy organs as they become available.

Several factors are considered when determining who will receive the available kidneys:

• Blood Type – Every person is a blood type A, B, AB, or O. For deceased donors, the blood type must be the same. For living donors, the blood types must be compatible.
• Tissue Type – Genetic matching to determine which donors are appropriate for you. If a perfect match is not available, the kidneys are allocated based on the closest match and time on the waiting list.
• Cross Match – A test which makes sure you don’t have antibodies in your blood that would cause you to reject certain donor kidneys very quickly.

Average Wait Times by Blood Type

• O – 4-6 year wait
• A – 3-4 year wait
• B – 4-6 year wait
• AB – 2-4 year wait

Living Donation – the quickest way to transplant
A family member, friend or other unrelated person may be able to donate one of their kidneys to you. Of all potential donors, living donors are the best. If you have a potential living donor, please ask your Transplant Nurse Coordinator for further information about this option.

While You Wait
Your life changes the moment you are diagnosed with severe kidney disease. You must take very good care of yourself, and this increased self-care will continue for the rest of your life. While you are waiting for transplant surgery, you must stay as healthy as you can – infections and other factors can postpone or even cancel your opportunity to receive a kidney transplant.

Patients who are properly nourished generally have fewer complications, spend less time on the ventilator after surgery and have a shorter recovery time. Combined with consistent exercise – walking at least 30 minutes several times a week and lifting small weights (such as cans of soup) help you keep up your strength and stamina for surgery and recovery.

Be Prepared
As you are waiting for transplant, be sure to:

• Attend our pre-transplant class
• Keep in touch with the transplant team
• Notify us of any telephone, address or insurance changes
• Keep a suitcase packed, ready to come in for surgery
• Maintain your support network – you will need a friend or family member to drive you to and from the hospital, and support you before and after surgery
• Stay healthy!

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Getting the Call
When an organ is available, a Transplant Nurse Coordinator will call the number(s) you provide during your evaluation. You must be ready:

• Have a designated driver (you may need to have a back-up just in case) to bring you to the hospital.
• Bring toiletries, shoes, sleepwear and robe
• DO NOT bring money, credit cards, jewelry, flowers/plants, pets, fresh fruit or vegetables, children under 14 years of age, a large suitcase or excessive clothes (all you need is sleepwear and something to wear on your way home)
• Bring your health insurance information, a list of your medications, list of important medical conditions or surgical history
• Have important phone numbers available and a copy of medical directives or living will
• Do not eat or drink anything once you have been called unless you have specific instructions from the transport coordinator

Arrival
When you arrive at University Hospital, you will report to the 12th Floor University Transplant Center Transplant Unit. You will have a series of exams, including dialysis (if needed) and a final cross match. Your transplant could be cancelled if you have any signs of infection, the donor kidney has problems, a new medical problem exists or the final cross match is positive for antibodies against the particular donor kidney. If there are any disqualifications, you will go back to the waiting list.

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Kidney transplant surgery is two to four hours long. You will be under general anesthesia. The transplant surgeon will make an incision just above the groin. The artery and vein of the new kidney will be attached to one of your arteries and veins. The new kidney’s ureter will be attached to your bladder.

After the surgery, you will wake up in the transplant ICU. You will have mild discomfort, and receive medication for your pain. You will be given medications and fluid through an IV for a few days. A catheter will be in place to help you pass urine. Some patients require dialysis for a short time if the donor kidney does not start working immediately.

You will receive many instructions about your medications and how to care for your transplanted kidney. You will remain in the hospital for 5-6 days.

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When you leave the hospital, you will receive an appointment for your next visit to the Transplant Clinic and for a procedure to remove a tube in your bladder. You will visit the Transplant Clinic weekly for the first month and we will continue to follow you closely for a few weeks afterward. Be sure to bring your medications and Transplant Manual to ALL of your appointments. We will give you instructions for lab work or other tests you may need to monitor your progress. The visits will gradually decrease. After three months, you should return to your regular doctor for follow-up care.

Medications after Transplantation
Your body tries to get rid of anything it considers foreign. It will try to reject your transplanted kidney. In order to prevent rejection, we will give you immunosuppressive medications. These will reduce your resistance to infection, so we will also give you medications to help your body fight infections. Here are some of the medications you will take after transplantation:

• Immunosuppressant “anti-rejection” medications
• Sterioids
• Antibiotics
• Antiviral
• Antihypertensive
• Diuretics
• Vitamins and Minerals
• Medications to prevent stomach ulcers
• Cholesterol lowering agents

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