Kidney Transplant Evaluation and First Visit
From day 1, you will receive comprehensive and compassionate care from our multidisciplinary kidney transplant team. Our staff will answer all your questions and thoroughly assess your condition to determine your best treatment option. If a kidney transplant isn't right for you, we'll discuss alternative treatments with you.
Before your visit
Your physician and dialysis team should supply all relevant medical information to us before your initial evaluation.
Our care team is here to guide you through every step of your transplant journey. We’d like to share some important educational material to help you understand what’s ahead of you and what to expect. You and your loved ones can view this 35-minute kidney transplant video at your convenience as you prepare for a future transplant surgery. We look forward to partnering with you on your way to a new chapter of life.
Of course, we are always here for you to discuss your questions or concerns.
Natasha Perez: Hi, my name's Natasha Perez. I'm a Pre-Kidney and Pancreas Nurse Coordinator here at the health system. You are here today to do your kidney and pancreas transplant education. If you are watching this prior to your evaluation appointment, just follow along with the slides. If you were in your evaluation, you will have a folder that I will reference throughout the slideshow. So the first photo here is our transplant team. These are our transplant nephrologists and our nurse practitioners shown. At this time, please pull out your medication list and make sure your name and date of birth is at the top, and we will collect it later. The things we're going to discuss today are facts about the waitlist, types of kidney donors, the risks and benefits of transplant, the evaluation process, the waitlist, and the annual updates that are required, donor kidney classifications, and that is the donor organs that are offered to you, being transplanted and the hospital stay associated with that, and then your post-transplant care.
Natasha Perez: Some new terms that we're going to reference through this slide show are the center for Medicaid and Medicare or CMS, the United Network for Organ Sharing or UNOS and Midwest Transplant Network or MTN. And those photos associated with that will be referenced on a slide show to know that that education is provided due to those organizations. If Medicare is a coverage you carry, here at the health system, we follow the guidelines associated with Medicare, so your benefits can be maximized here at our center. This will cover your transplant evaluation. It'll help cover surgery costs, and also immunosuppression for 3 years after transplant. UNOS or the United Network for Organ Sharing is an organization that helps kind of facilitate transplant. They help establish fair and equitable sharing policies between all other transplant centers. They also maintain the national waitlist and they also raise awareness about donation. MTN or the Midwest Transplant Network is a non-for-profit, organ procurement organization in this area. Their roles are to help support the donors across all of Kansas and Western Missouri. They raise awareness about donation and help give education about the need for organ donation, tissue donation and eye donation.
Natasha Perez: SRTR or the Scientific Registry of Transplant Recipients is a place where you can go and look up the success rates of transplanted organs at the 1, 5, and 10 year mark after transplant. You can look this up at any transplant center across the United States. You just have to go to this website, the srtr.org. Here is 1 of our graphs here associated with our health system on the survival rate of our graphs at that first year mark. In your folder is provided a packet that will show you multiple graphs as well, and also how to access this information.
Natasha Perez: This slide shows some waitlist facts. So at any given moment, there is an average of 100,000 people waiting on the transplant wait list for an organ. Just in the past few years, last year, we had completed 18,000 transplants. Of those 18,000 transplants, 12,000 were from deceased donors and 6,000 were from living donors. That is why there's such a long wait for organs. Only 18,000 of 100,000 people waiting were transplanted. Also yearly, 4,000 people pass away waiting on the wait list for an organ.
Natasha Perez: Here's some outcomes that show why being transplanted prior to the start of dialysis is very important. So another fact to take is that getting transplanted prior to the start of dialysis actually is a benefit to you. You are more likely to survive from these other diseases or cancers than being on dialysis for 5 years. So more likely to live with prostate cancer, treated after prostate cancer for 5 years, than you are to survive 5 years on dialysis. So it's very important to try and get help before you start dialysis.
Natasha Perez: Okay, so there are 2 types of transplants you can receive. One is a living donor transplant, and the other is from a deceased donor. Living donor transplants are the gold standard for transplant. It's proven to have better success rates, shorter wait time, you'll have a scheduled OR time instead of a random call at any time of the day, and there's better matching options, if you don't match your recipient. So most people have the question, does a living donor have to have the same blood type as me? And no, they don't. Here at the health system, we have multiple options. We have paired kidney exchange or incompatible exchange or compatible sharing. This is where if your donor does not match you, then you can change with someone else who also does not match their recipient. This will cause a swapping of kidneys and everyone will be able to get transplanted.
Natasha Perez: Some other questions that donors have is does my donor need to live locally? And no they don't. They can complete their testing back home where they live. Does my donor need to pay for their medical workup or surgery? And no they do not. Your insurance covers all of their costs for their evaluation and surgery. And sometimes your insurance has benefits to cover travel and lodging.
Natasha Perez: So here's some resources that we have here. You can reach out to the living donor team and they can help you get some of these resources. Also, we have cards that you can hand out to potential donors saying that you need help. And then there's also a website called, The Big Ask, The Big Give, and it is a resource you can use. The Big Ask, Big Give is a website that you can go onto to get resources to help you write letters or other items of reaching out to say you need help to find a donor.
Natasha Perez: So the actual kidney transplant. We will leave your original kidneys in place. And then the new transplant will go down low in your abdomen, close to your hip bone. The incision is pretty small. It's about 4 inches long, and it's the shape of a check mark. Most likely closed to staples. If you need a kidney and a pancreas transplant, then it's a much larger incision. We will be putting 1 organ on each side of your abdomen, down low by your hip bone, and it'll be a large midline incision. This will also require you to stay in the ICU for closer monitoring.
Natasha Perez: So there are some clinical studies that we do here at the health system. And this is just to provide access to better care for transplant patients. This is also changing the standard of care as well, to increase the longevity of your kidney function. The Gift of Life is a mentoring program that is offered here in the Midwest region. And it helps any transplant patient, either in the pre-process, post-process. They also are there to support people who want to be potential living donors or also people that are just a support person. You can reach out to Andy Donnelly and he will set you up with someone who's going through the same experience you're going through. So if someone wants to be a potential living donor, he has living donors that have been through that process here at the health system, and they will contact you via either phone, email, in person, whatever works for you and your family. This is a free service that is offered here.
Natasha Perez: So the evaluation process, that's where everyone is here today to start this. We hope to get everyone through within the first 90 days. This depends on each recipient. So if you required more testing, such as specialty testing, that it may take longer to get those appointments scheduled with those cardiologists and such, so it may drag out that 90 days. If you're young and healthy and don't have a lot going on, then you may get through it quicker. But for most of our individuals going through this process, will require a chest X-Ray every year. CTs we'll do as necessary. And then everyone will need some form of cardiac clearance, whether that just starts at an EKG, or we can go all the way up to a cardiac cath, but most of everyone gets an echo and stress test.
Natasha Perez: All of your cancer screenings need to be done through your primary care provider. Those are for example, your mammograms, pap smears and colonoscopies, because they would follow up with any results coming from those tests. Sometimes we do require dental clearance. We'll let you know that if it is necessary.
Natasha Perez: So after today, we will give you an after visit summary. This will have a list of items that you need to start working on to get through your transplant evaluation. It will also have your vital signs and things like that from clinic. It will also have a number on it for you to sign up for My Chart, if that's something you're interested in.
Natasha Perez: Next, we will take you to a selection committee as a new candidate. We'll discuss you and then get the details of your evaluation lined out, so we can give you the exact things that you need to complete in order to get on the transplant wait list. Good things to do are to go ahead and contact your primary care provider and go ahead and get established or just start your cancer screens, if they need to be up to date. A good thing to do is go ahead and establish with a dermatologist. Skin cancer's the one of the most common cancers after transplant. So getting established with one now would be a benefit to you.
Natasha Perez: Selection committee is where everyone that you meet in your room today, we meet as a group every Wednesday and we discuss the new candidates that are here for our transplant evaluation. We also discuss any candidates that are ready to be listed or need further testing. So there are 3 decisions that can come from committee that can be either you are approved, yes, we're willing to place you on the waitlist here at our health system. Two, you're deferred, maybe you need to go complete an echo or stress test. Three denied, and we would tell you reasons why we could not transplant you at our center.
Natasha Perez: So some things you have to meet in order to get approved here at our transplant center is that you need to have advanced kidney disease. That's either being on dialysis or having a GFR less than equal to 20. You need to be suitable medically and surgically. You need the financial resources to cover your transplant and the immunosuppression after. We do require social support. And that is just because you're going to need some assistance after transplant getting to and from the hospital and to just picking up medications and things like that. Also, we need to have all the testing completed in order to proceed. And then we also want to make sure that you're able to follow medical recommendations. This is very strongly recommended because after transplant, you'll get your labs drawn potentially 2 times a week, and we will just call you after and change your medications over the phone. So we want to make sure you can follow recommendations now, so you can follow those easy steps after transplant as well, and be successful.
Natasha Perez: So getting listed with UNOS. First, you need to be approved in our selection committee. Also, some insurance companies require a listing authorization in order for us to list you for transplant. This is where your insurance company is saying, "Yes, we'll pay for transplant." And they give us a very long fancy code to do so. We also need to make sure you have an updated, MTN sample in their lab, so then you have something to be compared to for donors. Once you're active on the waitlist, we'll just need to see you once a year. And you'll also need to submit a monthly blood sample to MTN. If you're on dialysis, your dialysis center will do this for you monthly like clockwork. If you're not on dialysis, we will mail you these MTN kits. Inside these kits is everything you need. There will be a styrofoam package with a tube in it, for them to put blood in. There will also be a prepaid FedEx package.
Natasha Perez: So you'll just go to an outpatient lab. You'll get your lab drawn, they'll put it in here for you. And then you need to just place it in your FedEx bag and drop it in a mailbox to get mailed to MTN. And you will do this every month. So wait time. So once you're listed, it starts a time clock. So if you are not on dialysis, it just starts a timer, and it grows from there. If you are on dialysis, you will get credit for that time of dialysis. So if you have been on dialysis for 2 years, if we were to list you today, you would then have 2 years of wait time already. Wait time is 2½ to 3 years in this area. It depends on multiple factors. This is, your blood type, organ availability, and your antibody level.
Natasha Perez: The list is constantly changing. Someone is added to the waitlist approximately every 14 minutes. So as I mentioned before, while you're on the waitlist, we just need to see you once a year. This is to update all of your important information, such as medical changes, insurance, phone numbers, and et cetera. Phone numbers is a big thing to keep us up to date on. That is how we reach you for organ offers, so making sure your emergency contacts are updated as well, we depend on those sometimes in the early hours, when we call you with organ offers. We do recommend you sign up for My Chart. It is a tool that is easy access to message your nurse coordinators, look at your lab results and see imaging that you've completed.
Natasha Perez: So with blood type, there are 4 blood groups out there. There's A, AB, B, and O. O is a universal donor, but they're also a giver and not a receiver. So, O will wait one of the longest times on the waitlist due to only being able to receive from O. A is a very common blood group, so it actually does not wait very long for transplant. B can only receive from B and O and AB can receive from every blood group. So they wait the least amount of time.
Natasha Perez: We need to talk about these A2 kidneys. So A blood group is a very common blood group and actually can be subtyped into 2 blood groups. It can either just be plain A, or it can be these A2 2 kidneys or blood type. These A2 kidneys act like O blood and can be given to all blood groups. So this is helpful for the blood types B and blood type O. It opens up an extra organ group for them to receive from, since they're the most limited. If you say yes to accept A2 kidneys, it just opens up an extra organ offer for you and hopefully get you transplanted sooner. You're not more likely to reject the organ. You don't form antibodies any faster. It literally acts like O blood and is at no increased risk.
Natasha Perez: Now we're going to talk about the kidney donor profile index score or KDPI. You will hear this used with every single organ offer that you receive. KDPI is what we use to give you a general idea on how long that kidney's going to last after it's transplanted. So it is given a score from 0 to 100%. And it's opposite of what you would think is a good score. So the lower the score, the longer that kidney's likely to last, and this is because it's a comparative score. It takes this one isolated kidney and it compares it to all the other kidneys that were procured in the previous year. So if this kidney has a score of 20%, then it will outlast 80% of all the other kidneys procured in that year. It's not associated with age. So you could have a kidney that's 70%, and it came from a 40 year old donor. This score is made from multiple factors. Some of those factors include age, cause of death, body mass index, creatine, and there's more.
Natasha Perez: So if we go to the other end of the spectrum, the greater than 85% kidneys. These kidneys, if you put in the same scenario as a score of 85%, they will only outlast 15% of all the other kidneys procured in the previous year. That doesn't sound too great, but these kidneys are not poor kidneys. And we have lined out a few candidates that we feel would be good to receive these kidneys. On the right side, in the very back, the last page is a KDPI sheet. It will line out what candidates we think are good to receive these organs. So that could be, do I have a high antibody level? Am I over the age of 60? Do I not have any wait time? These are things that could make you eligible to say yes, I should probably think about receiving these organs.
Natasha Perez: With these greater than 85% kidneys, we do, do biopsy on all of them. If the biopsy does not meet our standards here at the health system, then we will decline the organ for you. Now that does not mean the organ does not get used, they do go to other centers and are transplanted and people do well. These kidneys do tend to last about 5 to 7 years or more after transplant.
Natasha Perez: The reason we ask these questions and let you know about these organs is because when we list you for transplant, we want to know what you're willing to accept. So if you say, "Yes, I want to accept greater than 85% organs," then we will put you in listing for receiving all organ offers. You will receive phone calls for organs from zero to 100%. If you say, "No, I don't even want to be bothered with those organs," then we will list you to only receive calls for zero to 85%.
Natasha Perez: So EPTS or the Estimated Post-Transplant Survival Score, is your score as the individual receiving the organ. So KDPI covers the kidney that's offered to you and EPTS is your scores of the candidate. It also is a score from 0 to 100%, and it's based on 4 factors, your age, number of previous transplants, your time on dialysis, and if you have diabetes. You can go online and look up your score by getting on an internet browser and Googling EPTS. It'll pop up with a calculator. It'll ask you for those 4 items and you'll put them in and it will give you a score. If your score is 20% or less, than you will receive organs with KDPI scores of 20% or less, over others with more wait time. And this is to match longer-lasting kidneys with younger individuals. We want to make sure that someone who is young, who will need probably most likely more than one transplant in their lifetime, we want to give them a longer lasting kidney the first time, because we know it will be harder to transplant them the second time.
Natasha Perez: Okay. So getting the call for your organ offer. We do call from unknown and blocked numbers. So don't have that feature blocked on your phone. We also want to let you know that it is time sensitive. We do only have an hour to respond to an organ offer. When we call it'll be any hour of the day. At first, we tell you about the organ offer and see if you'd like to be put in for cross-match. If you say yes, then we'll go over your questions as the recipient, to make sure that you're healthy enough to be transplanted at this moment.
Natasha Perez: After that, it could be several hours before we call you back and that is because the cross-match or the comparison of you to the donor, take 6 to 8 hours to run. Also, we'll ask you questions in regards to your health to see if you are healthy enough to proceed with a transplant at this moment. If you're currently sick with the flu when we call you, it is not a good idea to transplant you, as we'll be bringing your immune system down with immunosuppression to help you prevent rejecting the kidney we're going to put in.
Natasha Perez: Though if you're the primary person, we could potentially call you all the way into the hospital and you'll be sitting in our beautiful green gowns, and we could potentially call off surgery. This could be due to multiple factors. It could be maybe the biopsy was bad, or maybe the donor finally went to surgery and the surgeon saw something inside that was not good to transplant. So we would never transplant you with something that is not appropriate. When you're getting an organ offer, this is what is happening. A donor has become available and the hospital has notified MTN. They go to the bedside to assess the donor. If everything's good, then we proceed with running the UNOS waitlist. The appropriate centers will be contacted on whose eligible for that organ at that time, and then we would be contacting you as the recipient to receive that organ.
Natasha Perez: PRA or Panel Reactive Antibodies are the antibodies that are in your blood. This is your immune system, if you've ever been exposed to anything foreign. So some people have no antibodies built up over a chronic basis, and some individuals have antibodies. This can come from receiving blood transfusions, pregnancies, transplants, even immunizations can cause a spike in your antibody level temporarily. When you send your monthly antibody level, this is what we're testing. We are looking to see if you've been exposed to anything that could potentially have your immune system fired up and ready to go against this organ that we're putting in.
Natasha Perez: So the cross match is where we are taking that monthly sample that you turn in, which is looking at your antibodies and we're comparing it to the donors. We already know you're a blood type match. We're looking at antibodies, your immune system. Will you react to putting this kidney in you? If there's no reaction, then you pass your cross match and it's okay to proceed with the transplant. Like I said before, this test takes 6 to 8 hours to run. Some things that can delay this, is if the donor is far away and we have to ship the blood to us to do that test here.
Natasha Perez: So now we're going to talk about types of organ offers. The types we're going to talk about is brain death, cardiac death, En bloc offers and increased risk offers such as Hepatitis B, C and HIV. Donation after brain death. This is where a donor has been declared brain dead by a physician, and they are in the ICU on life support. This is what we consider a standard donor. When the donor goes to the OR to have their organs procured, the organs will receive blood flow all the way up to the point of removal.
Natasha Perez: Another donor is a Donation After Cardiac Death or DCD. This donor does still have brain activity, but family has chosen to remove life support. So what will happen next is the donor will then go to the OR. They will remove the life support. The donor needs to pass within the first 90 minutes in order for us to be able to use those organs. If the donor does not pass, then we cannot proceed with those organs. What's going to happen is the donor's heart needs to slow to a stop and they will pass. During this time, blood flow is decreased to the organs, and so this could cause a risk for delayed graft function in you as the recipient receiving.
Natasha Perez: Another type of organ offer is En bloc kidneys. These donors are small children or infants. Instead of receiving 1 adult kidney, you would actually be receiving both of that child's kidneys. They will still be placed on 1 side of your abdomen as just a little bunch. And these organs will grow with you over time. So you will also have multiple arteries that the surgeon is sewing in, and you'll also have 2 ureters that will be sewn into your bladder because you're receiving both kidneys, which both have a ureter. So this will cause you to have 2 ureteral stents. With these organ offers because they come from a small child or infant, they tend to have higher KDPI scores. Like I said before, body mass index is a factor that is calculated into that KDPI score, and due to them having a smaller body mass index, it sometimes drives that kidney's score up. So there is chances that these kidneys can be greater than 85% occasionally, but you have to remember that they are a pediatric organ. So they are great long lasting organs.
Natasha Perez: Now we're going to talk about the increased risk donors. So all of our donors are tested for infectious diseases, such as HIV and Hepatitis, but as informed consent, we have to let you know if the donor has participated in an activity that the Public Health and Safety Services has deemed as an increased risk for obtaining those diseases. Some of the items that can make a donor increased risk is a day of jail time in the last year, selling sex for money, IV drug users, male to male contact, or sometimes even if the family does not know any medical history on that donor.
Natasha Perez: So if its distant family that lives in another state and doesn't really know the activities of that donor, then we just err on the side of safety and put them as increased risk. You can accept or decline these organ offers and they do not change your place in line for the next organ. It does not affect your candidacy. And that is the same with any organ offer that is offered to you. It does not matter if it's increased risk or if it's a 2% KDPI. It is your choice as the organ you're receiving.
Natasha Perez: So now we're going to talk about Hepatitis B and Hepatitis C organs. So if an organ offer comes to you and it is Hepatitis B core positive, that means the donor had been exposed to Hepatitis B, but does not have an active infection. If you're on dialysis, you've already had your Hepatitis B vaccinations. So in theory, if you were to receive these organs of Hepatitis B exposure, then you would not obtain Hepatitis B.
Natasha Perez: Next are the Hepatitis B antigen positive donors. When it is antigen positive, that means the donor has an active infection of Hepatitis B. If you were to be transplanted with 1 of these organs, you would obtain Hepatitis B upon transplantation, and then you would undergo the treatment after to treat the Hepatitis B. Now, this is the same for Hepatitis C. If it is Hepatitis C antigen positive, they are positive for Hepatitis C and have the infection. You would obtain that with transplantation and require the treatment after transplant, which is just an oral medication treatment for 6 to 8 weeks.
Natasha Perez: HIV positive donors. This is where the donor has HIV. We would not transplant this into someone who does not have HIV. Our health system is going to potentially open the doors to people who have HIV as the recipient. So they would be eligible for these organ offers.
Natasha Perez: The transplant hospitalization. So once you're transplanted, you'll be here 3 to 5 days. You'll have all the things you love. You'll have IV fluids, SEDs, those are the squeezy things that go on your legs until you get up and moving around, lots of medications, and then you'll also get an inpatient coordinator. She's going to give you a binder that has everything you're going to need to know about how to take care of your new kidney.
Natasha Perez: With your transplant, you're going to have a ureteral stent. So when we do your transplant, when we take the donor's kidney, we take the donor's ureter as well. That is the tube that connects the kidney to the bladder. So we'll take the donor's ureter and connect it to your bladder. Because that is such a tiny tube, we need to put a stent in it to hold it open, to make sure it heals correctly, and then also to make sure that urine can pass smoothly into the bladder. We leave the stent in for 4 to 6 weeks, and then it will be removed in an outpatient setting by a urologist. There's no anesthesia involved. It's just lidocaine to the area and they go up and pull it out.
Natasha Perez: Once discharged, you'll be seen in our clinic 2 times a week for the first couple of weeks. If you live more than an hour away from the hospital, we'll require you to stay locally for those first 2 weeks. If you live far away enough for plane travel, then you'll be required to stay here for 8 weeks locally. And that is just to ensure the safety of that brand new transplant, because we'll be doing labs so frequently and changing medication dosing.
Natasha Perez: You still may be getting labs drawn weekly for a time being until we get your medication stabilized for your body. Everybody is on a different level of immunosuppression. And so we will get labs drawn as needed depending on how stable your meds are. And those can be done closer to home, once you've gone home.
Natasha Perez: What is rejection? Rejection is your natural immune response to something foreign entering your body. So it is most likely to happen in the first 3 months, but it can happen any time. And it is highly linked to how you get your labs drawn and following up with your providers. So please don't discontinue any of your medications without consulting us first. Constantly getting your labs done is how we monitor the rejection because we can see rejection in your lab work before you would ever feel it. Rejection isn't normally just an abrupt stop in kidney function, it typically is just a small change here and there that slowly... Rejection is not just an abrupt stop in your kidneys function. It is a more how your kidney disease progressed, a slow burnout of that kidney. Kidney function will just slowly decline over time because it takes a while for your antibodies to build up and effect that kidney's function and tissue.
Natasha Perez: Anti-rejection medication or immunosuppression medication that we put you on, does put you at an increased risk for infection because we're lowering your immune system. It also puts you at increased risk for cancer. Like I said before, skin cancer is the most common type of cancer after transplant. And then it also can impair that kidney's function. So having your immunosuppression at too high of a level, can cause injury to the kidney, but also having it too low could cause your antibodies to come up and attack your kidney.
Natasha Perez: Certain types of immunosuppression are known to cause birth defects. If you're a woman, we ask you to refrain from becoming pregnant or let us know that you want to become pregnant so we can change your immunosuppressions around to better support you in that time.
Natasha Perez: For any men receiving a transplant, you still need to let the surrounding people who handle your medication know that even touching your immunosuppression medication, can cause birth defects. It can be absorbed through the skin. So either tell any women who want to become pregnant or who are pregnant, to either not handle your medication or to wear 2 sets of gloves, if they need to touch it.
Natasha Perez: So to sum this up, we're going to get you in a room. We're going to have you meet all of the providers. We are going to have you sign your forms and get you ready for clinic. There may be lab work done today and potentially some imaging. Your nurse will come in at the end and give you a to-do list of items that you may need to complete in order to get listed for transplant. After today, plan for us to take you to selection committee, to discuss you as a new candidate for us. Your nurse coordinator will follow up with you the next day to tell you the items needed in order to get listed, that have been discussed by all of the team members.
Natasha Perez: So now we're going to talk about the forms you need to sign. We're going to go over the release of information, your ethnicity form, your education checklist, and then the pregnancy and transplant form. So the release of information form is a form that we need you to sign and date the bottom of. Do not fill out any other information on there. This is scanned into your chart. We print it off as needed. So if you have completed testing outside of the health system, this is your permission for us to obtain that record, so you don't have to repeat it.
Natasha Perez: Next, we'll have you take out the ethnicity form. This form is used for when we list you within UNOS. There are certain markers with different heritages that is helpful for us when we're comparing you and matching you to donors. So if you can please mark all that apply and sign and date the bottom.
Natasha Perez: Now I'll have you pull out your education checklist. If you would like to initial next to the first 4 items, this is your acknowledgement that you've had this education class and I've gone over the education slides and that you've received your packet. The next item that I'll have you initial is the KDPI, and EPTS scoring. This states that I gave you education over KDPI and EPTS.
Natasha Perez: The next item is the A2 kidneys. Initialing here says you know what an A2 kidney is or non-A1 and marking yes or no is whether or not you would like to accept A2 kidneys. Like I said before, this is a benefit for blood types B and O, it gives them an extra organ group to receive from.
Natasha Perez: The next section is greater than 85%. Initialing there, says you know what a greater than 85% kidney is. Marking yes or no is whether you would like to accept greater than 85% kidneys. If you say yes, then that means you will be listed to receive organ offers from 0 to 100%, and then you can make the decision at the time of organ offer if you'd like to proceed or not. If you say no, that means we will list you to only accept organs from 0 to 85%.
Natasha Perez: Next section is the Hepatitis B, C, HIV and increased risk. Initialing next to those 2 items says you've had education. It does not mean you will be accepting those organs. The last 1 is the immunosuppression acknowledgement saying, "Yes, I know my immunosuppression medication can cause fetal harm or birth defects." Initialing there is saying that I am acknowledging that.
Natasha Perez: Last thing to do is to print, sign and date. The last form in your packet is for our female patients only. This is the mycophenolate form stating, "Yes, this immunosuppression can cause birth defects. And I am acknowledging that I will refrain from becoming pregnant while taking this medication." If you can please just print and sign the top of that form.
Natasha Perez: And now we'll take time for any questions. And if you're completing this prior to your evaluation, we'll call you to have these questions answered. Thank you for watching.
Living kidney donation is a gift of life
During your first visit, you will meet with our transplant coordinator, transplant financial coordinator and transplant social worker. Together, you'll review the transplant process, your financial needs and your psychosocial needs.
After your first visit, our doctors will conduct physical examinations to ensure your body is strong enough to undergo transplant surgery and determine your compatibility with living donors. Transplant evaluation tests can take 2-6 months to complete.
The tests we perform depend on your specific condition and may include:
These include identifying your blood type (A, B, O or AB), antibody levels and cross-matching to determine whether you'll accept or reject a particular kidney.
This painless and harmless test uses high-frequency sound waves to make images of the insides of the 2 large arteries in your neck.
This test uses intravenous or IV drugs to evaluate how the heart responds to stress.
This test examines the lungs and lower respiratory tract to help detect infection or abnormalities in your lungs and to assess the size of your heart.
This noninvasive test shows the blood flow through the arteries and veins in the lower abdomen and legs. It reveals any narrowing caused by hardening of the arteries or other vessel diseases.
This ensures you do not have infections, cavities or gum disease.
This noninvasive test uses sound waves to create a moving picture of the heart. Echocardiograms use no radiation and show more detail than X-ray images.
Women have a Pap smear and mammogram.
Ultrasound shows the blood flow to and from the kidneys and locates abnormalities or masses in the kidneys. We'll perform an ultrasound test of your abdominal area to check for any abnormalities of the liver, gall bladder, bile duct, spleen and pancreas.
Both the patient and donor are given skin tests for tuberculosis, a highly contagious infection. TB can be transferred to a patient via a donated kidney.
We check for infections and measure how well your kidneys get rid of wastes.
When you're approved for transplant
Once your transplant is approved, your case is officially activated. The transplant coordinator will put you on the waiting list of United Network of Organ Sharing. We'll also inform your doctor of your transplant status.
While you wait
While you're on the waiting list, it's critical that we have all your current telephone and pager numbers to reach you. You'll also need periodic lab work and yearly tests to be sure you are still a transplant candidate.