Q. Who is a candidate for a kidney transplant and what are the types of transplantation possible?
A. People whose kidneys have permanently failed due to chronic end-stage renal disease caused by diabetes mellitus, hypertension, autoimmune disease, congenital abnormalities or because of infection or trauma (injury) may be candidates for a kidney transplant.
There are two ways a kidney can be donated:
- Living donor: A donated kidney from a living person who has agreed to donate one of his or her healthy kidneys while alive. Living donors do not have to be blood relatives of yours and can be spouses or friends.
- Deceased donor: A donated kidney from a person who has irreversible brain injury and has previously registered to become an organ donor or the family wishes to donate.
Q. What is involved in evaluation testing prior to the transplant?
A. During your outpatient clinic evaluation visit, our goal is to have all the pre-transplant initial testing, lab work (including tissue typing) and an array of clinical testing, education, surgeon interview, and social work consultation completed in one day.
Every patient being evaluated for kidney transplant will have a psychosocial assessment with a social worker. The purpose of this evaluation is to help determine if a transplant candidate has the psychological stability, motivation and personal support to meet the challenges of transplantation. Before the appointment, you will complete a psychosocial survey that will be reviewed during the evaluation.
Following initial testing, the transplant team evaluates the information gathered and determines whether transplantation is appropriate. We will also determine what additional information is needed prior to placing you on the transplant list. These tests are customized based on your history and conditions, thus avoiding unnecessary testing and costs. It is preferred that these tests be completed at Ohio State’s Wexner Medical Center, but depending on your geographic location or payer preference, they may be completed closer to your home.
During the pretransplant clinic visit, you will take part in a comprehensive education program that details the surgical procedure, medications, recovery and rehabilitation associated with the transplant process.
Q. What is tissue typing?
A. The Tissue Typing Laboratory assures that a graft is immunologically compatible with its recipient. The process involves matching a person's unique configuration of six human leukocyte antigen (HLA) molecules with a potential pool of approximately 100 different varieties.
Cross-match testing helps prevent hyperacute rejection. The testing involves mixing cells from the donor's and recipient's serum to determine whether rejection promoting antibodies will occur. If they do occur, you will not receive an organ from that particular donor.
Transplant support testing includes monitoring new drugs that patients use, testing to determine a patient's overall ability to maintain a graft, and developing new tests to support many of the clinical aspects of transplantation.
Q. How do you get on the list to receive a kidney transplant?
A. Following initial testing, Ohio State’s transplant team evaluates the information gathered and determines whether transplantation is appropriate. We will also determine what additional information is needed prior to placing you on the transplant list.
If approved for transplant listing, the final step involves approval by the Ohio State University Wexner Medical Center Committee, and then by Ohio Solid Organ Transplantation Consortium (OSOTC). The OSOTC has a committee comprised of representatives from other transplant programs and other members who approve all patients for kidney transplant listing in the state of Ohio. When approved by the OSOTC, you are then listed for kidney transplantation on the United Network for Organ Sharing (UNOS) national waiting list. A letter is sent to your insurance company providing recommendations for transplantation and requesting approval.
Q. How long will I have to wait once approved for a kidney transplant?
A. There are two options that affect wait time for a kidney transplant:
Living donor organs: Another option is when a healthy person agrees to donate one of his or her healthy kidneys while alive. Living donors do not have to be blood relatives of yours and can be spouses or friends. Wait times for patients who have living donors are greatly reduced from years to months.
Deceased donor organs: You may receive a donated kidney from a person who has irreversible brain injury and who has previously registered to become an organ donor or the family wishes to donate. Please be prepared to wait as long as three-five years for a kidney from a deceased donor because, although the number of patients waiting for a kidney transplant has increased dramatically, the number of available donor kidneys has not. In addition, the donor must have a blood type compatible with your own and be similar in body weight and size. Each potential donor also must be screened very carefully for disease, infection or trauma to ensure that you receive a healthy kidney.
Q. What happens when a suitable donor is found?
A. When a kidney becomes available for you, you will be notified by the pretransplant coordinator and admitted to the transplant unit, ninth floor of Rhodes Hall.
Ideally, surgery is performed as soon as the organ is available. However, using the latest perfusion techniques, Ohio State's Wexner Medical Center is able to transplant kidneys within 48 hours of recovery.
At the time of admission you will have multiple lab tests done to ensure you are ready for transplant. You also will be seen by the social worker and the nursing staff to complete your initial transplant teaching.
Q. How long is the kidney transplant hospital stay?
A. Your hospital stay is typically five to seven days.
Q. What is a TransChart?
A. You will have access to a patient version of the transplant electronic record called TransChart where you may view your medication list, lab values and vital signs. You can remotely enter your vital signs and lab values if you choose. TransChart is a unique and important tool for your recovery; you are encouraged to have this access.
You and your healthcare providers have access to a toll-free number which is staffed 24 hours a day by a transplant coordinator with immediate access to a transplant surgeon. The transplant team currently monitors the condition of more than 2,500 transplant recipients around the country. This unique service benefits you by providing access to the transplant team if you have questions regarding your transplant. Coupled with the electronic database, this service also provides a way to maintain constant contact with you so we can monitor your progress.
Q. How will I adjust to the lifestyle and nutritional changes I’ll need to make after surgery?
A. Licensed Independent Social Workers (LISW) specially trained in transplant, assist you in adjusting to lifestyle changes brought on by your disease and its treatment. A registered dietitian specializing in the care of transplant patients will assist you by individualizing your nutritional care and educating you about your dietary needs.