Preparing for transplant: Evaluation, finding a match, costs and surgery

Evaluation for transplant

Before you know if you qualify for a kidney transplant, you must have a full health evaluation by a transplant team at a transplant center. The evaluation will help the transplant team decide if you are ready for the kidney transplant. If the transplant team decides you are ready, the next step will be for your transplant team to help you find a kidney match. 

On the day of the evaluation, you and your family will meet the members of the transplant team. The evaluation may take only one day, or it could take several days.

You will need to have several health tests and exams at the transplant center before the transplant team can decide whether the surgery will be safe for you.

The tests you may need include:

• Blood and tissue type tests
• Tests for HIV and hepatitis
• Prostate exam (for men)
• Mammogram and Pap smear (for women)
• Heart and lung exams
• Kidney and liver tests
• Colon exam (colonoscopy)

Since a kidney transplant is a major life change, it is important that you are not only physically ready, but mentally ready as well. The kidney transplant evaluation also requires a mental health evaluation. During the mental health part of the evaluation, you will meet with a transplant social worker who will make sure that you are mentally ready to have a kidney transplant and able to follow all of the directions about caring for yourself and your new kidney.

The transplant team will also ask questions about your finances, your support system, and your health insurance policy to plan and prepare the best care for you. You and your family will get important information about preparing for the transplant, what to expect during the recovery period, and medicines you will need to take.

If your transplant team decides that you are ready for transplant after you finish the evaluation, you may be added to the national waiting list for a donor kidney. If you have a living kidney donor (a person who wants to donate their kidney to you), you may have your transplant as soon as both you and your donor are ready.

Sometimes the transplant team will decide that you are not ready for transplant if you have a health problem that could make the transplant surgery dangerous for you. If this happens, do not be discouraged, you can be evaluated again. Talk to your transplant team about what you can do to become ready for transplant.

Some problems that could keep you from having a transplant are:

• Having other serious health problems
• Drug or alcohol abuse
• Untreated mental health disorders
• History of missing treatment sessions or not taking medicines as prescribed

Benefits and risks of kidney transplant

For people with kidney failure, a kidney transplant can increase your chances of living a longer, healthier life. Because dialysis can only do part of what healthy kidneys do for your body, people who have a kidney transplant usually live longer than those on dialysis. A kidney from a transplant will not work as well as kidneys in a healthy person. But your health may be almost as good as a person with healthy kidneys, as long as you closely follow your doctor's orders after the transplant surgery.

Also, when you get a kidney transplant, you may avoid some of the complications that people on dialysis often have, such as bone problems and heart disease.

A kidney transplant can improve your quality of life. After your kidney transplant, you may have:

• More energy
• Fewer limits on what you can eat
• More free time from not having to go to dialysis
• More flexibility to travel
• Greater ability to work and hold a job

Risks with a kidney transplant are the same as with any major surgery. Risk does not mean these things will happen, but it means they could happen. Some of the risks are infection, bleeding, or damage to other organs. Also, the three connections between your new kidney and your body: the artery, vein and ureter (a tube that carries urine from the kidney to the bladder), might leak or become blocked. Read more about the kidney transplant surgery here.

Finding a match

Before having a transplant, you will need tests to see if the donor kidney is a match for your body. For the kidney to be a good match, the new kidney will need to be very similar to the other organs and tissues in your body so that your immune system will not attack it.

The job of your immune system is to find anything that should not be inside your body, attack it, then get rid of it to keep your body healthy. The immune system is meant to protect your body by fighting anything it senses can hurt you, such as bacteria from spoiled food or viruses like the flu. Because the donor kidney comes from another person's body, your immune system will notice right away that your new kidney is different than the rest of your body, then start to attack the new kidney as if it were a disease. To lower the chances of this happening, your transplant team will make sure that the new kidney comes from someone whose blood type works with your blood type.

There are four basic groups of blood types that people have: type O, type A, type B, and type AB. If your blood type is very similar to that of the new kidney, there is a lower chance that your immune system will try to fight the new kidney.

If your blood type is:

• O, you can only get a kidney from someone with type O blood.
• A, you can get a kidney from someone with type A or type O blood.
• B, you can get a kidney from someone with type B or type O blood.
• AB, you can get a kidney from someone with type A, type B, type AB or type O blood

Transplant team

The transplant team is a group of medical professionals who evaluate you to decide if you qualify for a kidney transplant. They also manage your medical care before and after the transplant. The transplant team is usually made up of:

• Transplant coordinators organize the patient evaluation, prepare patients for the transplant, and organize the treatment and follow-up care after the surgery.
• Transplant physicians are doctors who handle patient medical care, and prescriptions. The transplant doctor does not perform the surgery but provides the medical care for the patient leading up to and after the surgery.
• Transplant surgeons are the doctors who perform the actual transplant surgery and work closely with the rest of the transplant team right before and right after the surgery.
• Financial coordinators work with the transplant coordinators and insurance companies to be sure that patient finances are in order throughout the transplant process.
• Transplant nurses are responsible for patient care before and after the transplant surgery. They play a major role in the transplant patient's recovery.
• Transplant dietitians teach transplant patients about how to make the best food choices before and after the transplant surgery. They may create special diets for patients before the surgery and will help patients adjust to their new diet after the transplant surgery.
• Social workers help transplant patients learn healthy coping skills to deal with challenges they may have before or after the transplant surgery, such as emotional problems, fear, physical side effects, or financial stress. They also connect patients to community resources and help with problem solving.

Courtesy of the Organ Procurement and Transplantation Network (OPTN).

Transplant surgery

If you have a living kidney donor, you will be able to schedule the date of your transplant.

If you are on the waiting list for a deceased donor kidney (a kidney from someone who has just died), as soon as a kidney becomes available you will get a phone call telling you to come to the hospital right away. Once you get to the hospital, you will have a blood test to make sure your body will not have a bad reaction to the donor's blood. If the test does not show a problem, the doctors and nurses will prepare you for the transplant surgery.

It is important to know that you might arrive at the hospital, ready for your transplant, only to find out that the donor kidney is not healthy enough to give to you. If this happens, try not to be discouraged — another kidney could be available soon!

During the transplant surgery

You will be placed on your back on the surgery table. You will be given anesthesia, a medicine to make you sleep only while the surgery is being done. The surgeon will make a cut on your abdomen, or belly area. Your new kidney will be put into your body in this area, and the donor's ureter (the tube that carries urine from the kidney) will be sewn to your bladder. Usually your own kidneys will not be removed. The surgeon will close the skin cut and you will be taken to the recovery room. This operation takes 2 to 4 hours.

Recovering from the transplant surgery

• After the transplant surgery, you will recover in the hospital where you will be watched closely. You will usually spend several days recovering in the hospital.
• In some cases, you may start making your own urine right away. Sometimes, especially with deceased donor kidneys, this will take a bit of time. If your new kidney is not producing urine right away, you will need to stay on dialysis until this starts happening.
• Your transplant team will adjust your immunosuppressant medicines and watch you closely for signs that your body is accepting the new kidney.
• Usually, the transplant team will recommend that you get up and start slowly moving around one day after your surgery.
• Once you have recovered enough to safely go home, you will be released from the hospital and continue recovering at home.

Recovering at home

• Once you are at home, it is extremely important that you follow the directions given to you by the transplant team for taking care of your body after the surgery.
• You will need someone to drive you home from the hospital and stay with you at home for at least a few days after the surgery.
• Do not drive until your doctor has told you it is safe.
• Do not do anything that would put stress or pressure on the area where you had the surgery, such as heavy lifting.
• Watch your weight and blood pressure very closely.
• Call your doctor right away if you notice anything strange or different about your health.

On average it may take six weeks for the place of your surgery to fully heal.