Pre-transplant recipient (patient) evaluation

Once the need for a transplant is perceived, patients undergo a formal evaluation which involves blood tests, CT and other scans, tests for heart, lungs and other organ systems and assessment by various specialists. Evaluation is performed with the following goals:

  • To establish the diagnosis and find the cause of Kidney disease.
  • To determine the severity of kidney disease and its effect on other organ such as liver, lungs, etc and thus determine urgency of transplant.
  • To actively look for cancer.
  • To evaluate the condition of other organ systems such as heart, lungs, liver, etc and determine patients ability to tolerate this major operation.
  • To evaluate difficulty, technical feasibility and risk of surgery.

Evaluation generally takes about 7-10 days and is done on outpatient basis. The evaluation period may be very hectic and stressful. Patients are advised to relax between tests and follow the instructions for each test carefully for accurate results.

The transplant coordinator is the main contact person during evaluation and will fix appointments in consultation with Nephrologist for tests or procedures. At every stage of evaluation, the plan for further tests may change depending on your reports. Therefore it is important to visit the hospital routinely for review by the transplant team.  Patients who are sick may be advised to undergo evaluation in the hospital. If unexpected problems are detected such as cardiac disease, thyroid disease, infection, etc., they have to be treated before transplant.

Patients with other co-existing diseases such as uncontrolled blood pressure, or untreated cardiac problems, might have to wait until they are corrected. Kidney transplant can even be performed after successful cardiac angioplasty or with heart bypass surgery.

If a suitable family donor is not available, after the recipient evaluation is found satisfactory, the patient is registered on the waiting list for a deceased donor kidney transplant.

Patients should make adequate arrangements for blood products and finances well in advance before surgery. While preparing for a transplant, all doubts should be clarified and understood. Patients and the donors are encouraged to meet other patients and families who have undergone the operation and are willing to share their experiences.

Dealing with Pre-Transplant Stress

Waiting for a transplant can trigger a patient’s feelings of stress and anxiety. To help manage stress, the patient should:

  • Eat right, take prescribed medications, and follow a daily exercise program. The transplant team will create a plan based on his medical needs.
  • Keep up with studies, work, and leisure activities, to the best of his abilities. The patient shouldn’t have to put everything on hold.
  • Share his feelings if he feels depressed or uneasy. The transplant team can answer questions, and help alleviate fears. A social worker or counsellor can also help you to cope.
  • Find a creative outlet, enjoying a hobby to the fullest. This will distract and help a patient relax. Or the patient could pursue a new interest – something that will absorb pent-up energy and leave positive feelings of fulfilment. The patient should ask his doctor for guidelines on these activities.
  • Spend time with family and friends. Good friends will take a patient’s mind off waiting. Laughter really is the best medicine.
  • Learn relaxation techniques, like reading and listening to music or relaxation tapes.

Preparing for surgery – Living & Deceased Donation

While you are waiting for a kidney donor, or you are a donor yourself, it is important that you take steps to improve your general level of health and well-being. This is because the healthier you are, the greater your chances of the donation being successful. Your hospital will be able to provide you with more detailed advice for your individual circumstances.

Two important pieces of advice are:

  • Give up smoking (if you are a smoker) – continuing to smoke could lead to further kidney damage
  • Lose weight (if you are overweight or obese) – as well as the health risks posed by obesity, performing surgery on someone who is obese is technically more difficult, and has a higher risk of post-operative complications.

Cadaveric or Deceased Donor Kidney

A cadaver donor kidney is one that comes from a person who is Brain Dead. The family of this person has given permission for the kidneys to be donated for someone who needs a transplant

If you are a potential recipient of deceased donation, and are on your hospitals waiting list, your hospital will need to be able to contact you at short notice, so you should inform staff at the centre, if there are any changes to your personal contact details. You should also inform them about any changes to your health, for example if you develop an infection.

Preparing and Waiting for a Kidney Transplant

Days and weeks may pass while the transplant team waits to locate the right kidney for a specific patient. During this time, the patient should prepare as much as possible and take positive steps to deal with the stresses of waiting, always staying focused on reaching the goal of transplant.

The Telephone as a Lifeline

As soon as a donor kidney becomes available, the coordinator will call the recipient to get ready. Since this call could come at any time during the day or night, the transplant team should be able to reach the patient whether he is at home, at school, at work, or on vacation.

The patient should provide his team with the phone numbers of family members and close friends as well, and do everything he can to make sure that he can be contacted immediately.

Be prepared

If you are waiting for a deceased donation, is a good idea to prepare an overnight bag and make arrangements with your friends, family, and your employer so that you are able to go to the hospital as soon as a kidney from a donor becomes available.

When a suitable donor is found, the hospital will contact you. It will check that no new medical problems have occurred and will ask you to go to the hospital.

When you hear from the hospital you should:

  • Not eat or drink anything
  • Take all your current medicines with you
  • Take a bag of clothes and essential items for your hospital stay

When the Phone Call Comes

When that phone call comes, everything will seem like a blur. The coordinator will advise the patient when to be present at the transplant center. The patient must move quickly, getting to the transplant center without delay. When a kidney becomes available, there is a time limit!

Make a List and Pack Ahead of Time

The patient should pack an overnight bag in advance as soon as his name is put on the waiting list. He should make a list of items he will need in the hospital after surgery, as well as a list of people to be contacted when the kidney becomes available. The patient should give this list ahead of time to a trusted family member or friend to pack any last-minute items and make the calls while the patient is on his way to the transplant center.

Getting to the Transplant Center

If the transplant center is nearby, the patient should plan to have a designated driver – if possible, someone who will be standing by when the phone call comes. This person should be available at all times and reachable by phone. The route to the transplant center should be mapped out in advance.

When you arrive at the hospital, you will be quickly reassessed. Some of the tests that you had during your initial assessment may be repeated to ensure that no new medical conditions have developed since then.

Living Donors

Overall risk to the donor is very minimal. Kidney donation for live kidney transplantation is a well-accepted procedure all across the world and is the best option for a recipient with ESRD (End stage renal disease). Ever since the first successful renal transplant conducted involving live identical twins in 1954, there has been an emphasis on the safety and usefulness of living kidney donation with respect to emotional benefit to the donor and better survival of recipient. Recent study published in New England Journal of Medicine on the life span of kidney donors was similar to that of persons who have not donated the kidney. The risk of end stage renal disease is not increased among donors and their health status is similar to that of general population. Their quality of life appears to be excellent. These may be the consequences of the routine screening of donors for important health related conditions at the time of donation and regular monitoring of blood pressure and necessary routine investigations.

Following are the information and the instructions the donors should be aware of before making a decision about donating their kidney:

  • The life expectancy of kidney donor appears to be similar to that of non-donors
  • Risks of major complications: The risks of donation are similar to those present in any major surgery, such as bleeding and infection
  • Risks of death: Death resulting from kidney donation is extremely rare and is estimated to be 0.03 percent
  • The short- term risks of undergoing donor nephrectomy (removal of the kidney) are very low and in general < 1.0 percent
  • The donor will have some pain and discomfort for a few days initially after surgery
  • Donor will have a scar of the surgery (few small ones in laparoscopic surgery)

Related Links
Transplant surgery
Post-transplant care

Refrences
www.unos.org
www.clevelandclinic.org
https://www.kidneyresearchuk.org
http://edition.cnn.com/2009/HEALTH/11/13/kidney.disease.diabetes/
http://www.worldkidneyday.org/faqs/about-kidneys-and-kidney-disease/kidneys-and-chronic-kidney-disease/

Fortis Memorial Research Institute
Dr. PN Gupta, Paras Hospital