Evaluation for Kidney Transplant
Receiving an organ transplant can be one of the most positive experiences of your life, improving your health and brightening your outlook. But at times it can be physically and emotionally draining.
A transplant offers more independence and a longer and better quality life. With a transplant, there are fewer restrictions on what you can eat and drink, and an overall boost in energy, all of which support a more active lifestyle. You will need frequent medical supervision after your transplant, but this intense care will gradually lessen over time.
Please understand that a transplant is a treatment and not a cure. You must be committed to transplantation as a form of treatment in order for you to embrace and manage the complexities of your care.
Transplantation may be a treatment option for you if you have kidney disease. An initial evaluation will be necessary to:
- Decide if you are healthy enough to receive a new kidney.
- Prepare you for your operation. This can take a long time, and there is no guarantee a kidney will be found.
- Learn about the options of a living or deceased donor kidney transplant.
- Identify possible live donors.
When Transplant is Not an Option
Transplantation is not a good treatment option for certain patients. If you have incurable cancer, or advanced heart or lung disease, you will not be eligible for a kidney transplant. Also, if you have scarring of the liver (cirrhosis), you will be considered only for a kidney transplant if you are eligible for a liver transplant at the same time.
Other possible barriers to kidney transplantation include:
- Active drug and/or alcohol abuse
- Not enough social support
- Uncontrolled or untreated psychiatric condition
- Noncompliance with medical treatment including a reluctance to follow a dialysis schedule, such as missing sessions or signing off early against medical advice
- Other active illness(es) that would compromise the success of your transplant, such as severe heart disease, severe peripheral vascular disease, infection, obesity, recent malignancy, and limited physical mobility without the likelihood for successful rehabilitation.
Healthcare Professionals You Will See
When we evaluate you for a transplant, you will see a number of healthcare professionals:
- Transplant nephrologists (medical kidney specialist)
- Transplant surgeon
- Transplant nurse coordinator
- Social worker
- Financial coordinator
People who have diabetes, or a history of heart problems, will see a cardiologist to determine what heart tests may be needed. People with hepatitis will see a hepatologist (a doctor who specializes in liver disease).
Transplant evaluation is an outpatient process. While many of the tests will be performed at the Transplant Institute, some can be done at a hospital or clinic closer to your home.
During the evaluation, you will undergo a number of medical tests such as:
- Blood tests to determine your blood type; liver and kidney function; viruses to which you may have been exposed such as hepatitis A, B, and C, and the AIDS virus; and tissue typing
- Chest x-ray to see if your lungs are healthy
- Electrocardiogram (EKG or ECG) to look for heart abnormalities or evidence of past damage
- Echocardiogram that allows the doctors to look at the function of your heart
- Stress test, which uses exercise or medications to stress your heart so physicians can check for evidence of coronary artery disease
- Cardiac catheterization if coronary artery disease is present
- Vascular studies such as an angiogram to assess blood flow to the legs if necessary
People who are over age 50 will need to have a colonoscopy, a study to check for colon cancer. Men over 50 will need a prostate-specific antigen (PSA) test to screen for prostate cancer. Women may need a mammogram and Pap smear.
Blood and Tissue Typing
Your ABO type will be determined (A, B, O or AB). In addition, we will test your HLA (Human Leukocyte Antigens) type, which is a test of certain proteins in your blood that are important for transplant matching. Although the HLA typing was very important in the past, with modern transplant medications, the effect of matching on the success of the kidney transplant is not as important today unless you have a brother or sister who is a perfect match. You will also have your blood checked for antibodies against human leukocyte antigens that may be on potential donors. This will help your doctors determine how hard it will be to find a suitable donor.
If a potential organ donor is identified for you, a test will be performed called the "crossmatch." In this test, a special laboratory mixes the serum (liquid portion) from your blood with white blood cells of your potential donor. The test will be positive if you have fighting units in your blood, called antibodies, that specifically attack the potential donor's cells. A positive crossmatch means that you cannot receive an organ from that particular donor, without a number of special procedures and medications (called "desensitization"). The test will be negative if you do not have any detectable antibodies against the donors' cells. This test will be important in determining your body's ability to accept a kidney from a particular donor, and will be performed at least twice before any live donor transplant.
Your transplant nurse coordinator schedules all appointments for tissue typing and crossmatch blood tests for you. If you have a potential living donor, our living donor nurse coordinator will schedule these tests separately for them. We do these blood tests in our tissue-typing lab. Please remember that the results are confidential, and cannot be shared without the explicit verbal or written permission of the person tested. There are no exceptions to this policy.
Psychosocial and Behavioral Health Evaluations
Part of the transplant evaluation process is to identify and try to resolve any psychosocial or behavioral health issues that might interfere with the success of your surgery and long-term recovery. Our behavioral health team includes a clinical psychologist and clinical social workers with extensive transplant experience. We also have access to BIDMC psychiatrists with considerable transplant experience. Our services include programs to help with:
- Managing the stress of illness, transplantation, or transplant care giving
- Improving quality of life before and after transplant
- Depression and anxiety
- Managing your medications
- Smoking cessation
- Losing weight
- Alcohol and drug relapse prevention
Strengthening your support system
behavioral health program helps improve care quality and patient outcomes by supporting transplant patients and
living donors, and their families, before, during and after transplantation.
Decision to Continue
The evaluation period gives you and your family the opportunity to meet with the transplant team and decide if you want to pursue transplantation at Beth Israel Deaconess Medical Center. Please remember that the ultimate decision to undergo surgery belongs to you, and you may withdraw from the program at any time. At any time during the process we are here for you and your family, to provide guidance and support, and to answer any questions you might have.