Evaluation of Candidates for Kidney Transplant
Potential kidney transplant candidates will complete an evaluation process which includes a variety of blood test, procedures, and consultations. Defining a clear picture of your health increases the likelihood of a successful outcome; therefore transplant candidates must undergo tests to determine their heart, lung and kidney function. Multiple tubes of blood and several urine samples are needed to assess the function of your immune system, kidneys, liver and general health. Blood samples will also be used to screen for viruses, evidence of cancer and tissue typing.
As part of your medical evaluation, you will meet with a team doctors and auxiliary staff. These include:
- Transplant Surgeon
- Transplant Coordinator
- Social Worker
At the evaluation conference you will meet with a transplant coordinator, who is a registered nurse specializing in organ transplantation. The educational meeting is conducted by the transplant coordinator. This meeting will describe all aspects of the transplant process. You are encouraged to bring family and friends to this meeting. The discussion includes detail of how candidates are selected for transplantation, risks and benefits, complications of the procedure, hospital routines, and care after you leave the hospital. Prior to this meeting you will be sent a transplant informational packet to review. During the educational session, ample opportunity will be provided for you to ask questions and discuss your concerns. The transplant coordinator will assist you and your family through preparation, education and listing.
The UI Hospitals and Clinics Transplant team has a multidisciplinary approach, which stresses the importance of treating individuals as a whole. We recognize the importance of the patients emotional and mental needs, as well as physical needs. A transplant social services representative will meet with you at your evaluation. The social worker gathers information about you and your family, your coping abilities, substance abuse history, support systems and ability to follow important post transplant instructions. This information helps the social worker determine your needs while you are in the hospital and how to better prepare you for the transplant experience. The social worker provides emotional support, information, helps plan for your discharge and can help you explore appropriate groups and service agencies in your local community.
Approval for Transplantation
When the evaluation is completed, the transplant committee will review the results of tests, procedures, and consultations. This committee meets every Friday and consists of the nurses, physicians, social workers and others who you have met throughout the evaluation process. Each member contributes their opinion; and a decision is made with regard to further testing, additional treatment and when you should be added to the waiting list.
If you are approved for transplantation, you will be placed on the recipient list of the United Network for Organ Sharing (UNOS). Kidney recipients are matched to donor according to blood type, tissue type and waiting time on list.
Living Kidney Donation
Blood, such as parents, siblings, adult children and more extended family members can relate living donors. It is also possible to have a donor who is not related by blood, but are emotionally committed to you. Examples of these donors are adopted family members, spouses, or life long friends. Excellent results can be achieved whether the donor is a blood related or not.
Great care is taken when considering a person for kidney donation. Above all, the team wants to ensure the kidney donor's health and minimize their risk. The following are contraindications for living kidney donor candidates:
- History of high blood pressure
- Kidney problems of their own
These conditions could lead to future health problems for the donor.
It is important the kidney donor is absolutely willing to be considered. Living kidney donation is an emotional decision. It is natural to feel fear and anxiety over the procedure, while maintaining a strong desire to participate. Our hope is to maintain the relationship between patient and donor, regardless of donation decision.
The following timeline is representative of the typical kidney recipient; no patient will have exactly the same experiences.
Day of Surgery
- You will be admitted directly to the Transplant Unit
- Blood samples will be obtained
- A chest x-ray and EKG will be obtained
- An enema will be given to cleanse the bowel
- You will go to surgery within hours of being admitted
- Usually lasts 2-4 hours
First Post-Operative Day
- You will probably come back directly to the Transplant Unit, but a small number of patients go to the Surgical Intensive Care Unit for a day or two
- You will not be eating or drinking until your bowel wakes up from the anesthesia, although you will begin taking pills with a few sips of water
- You will have an IV to prevent you from becoming dehydrated and through which you may get some medications
- You will have a Foley catheter placed in your bladder to drain your urine. This catheter usually remains in place for at least 4 days to allow your bladder to heal, and so that your urine output can be closely monitored.
- You will have your vital signs monitored hourly in the immediate post-operative period.
- You will have blood drawn once a day
- You will be assisted in taking your first walk within 12 hours after surgery, and will be expected to increase your amount of activity every day to prevent complications such as pneumonia and blood clots.
- You will be encouraged to cough and deep breathe to prevent pneumonia.
Second Post-Operative Day to Discharge (Post-Op Day 5)
- Most kidney recipients are discharged about five days after surgery.
- You will probably begin drinking clear liquids at mealtimes by Post-Op Day 2, and may even be eating solid food if it is tolerated.
- You will be learning your new medications, and signs and symptoms of both organ rejection and infection.
- A Transplant Coordinator Nurse will speak with you to arrange for local laboratory blood work and further follow-up.
- You will have your first follow-up appointment at the Organ Transplant Clinic approximately one week after discharge. You will be given the date and time of this appointment before you are discharged.
Follow up Care
For the first month after surgery your health will monitored closely by the transplant doctors and your transplant coordinator. You will be expected to keep a Daily Ledger for the first month after surgery. This Ledger should include the following information:
- Your temperature should be taken before breakfast and supper. Either a Fahrenheit or Centigrade thermometer can be used. Use a thermometer you are comfortable reading, oral glass, digital and tympanic thermometers are acceptable.
- It is important to weight yourself in the morning, after emptying your bladder, and before dressing and eating. Try to use the same scale every day for consistency.
- If your are taking medications for high blood pressure you will need to check and record your blood pressure before breakfast and supper. You will be given a blood pressure cuff and be instructed on how to use it prior to discharge form the hospital. You may need to continue to monitor your blood pressure after the first month if you are having problems with blood pressure or after having adjustments in your blood pressure medications.
- Kidney recipients with diabetes should check their blood sugars four times a day. After transplant insulin dosages frequently have to be adjusted.
Please bring your Daily Ledger to all clinic appointments.