Starting the Transplant Process
"Crossing the Bridge"
- Transplant Referral
- Evaluation Day
- Recipient Advanced Screening
- Consent for Evaluation Form
- Conclusion of Screening Tests
- Next Steps
- Living Donor Transplantation
- Deceased Donor Transplantation
The transplant process starts by talking to your nephrologist for consultation about having a kidney transplant. Your doctor will refer you directly to the Transplant Center at Virginia Mason in Seattle. Our transplant center will send you a letter letting you know we received your referral and that you are in our system. We will ensure that your health insurance coverage allows us to serve as your transplant center. The next step is a call from a nurse transplant coordinator. The purpose of this call is both to ask and answer many questions about the transplant process and clarify any initial problems.
As the evaluation continues, certain conditions or health problems may need to be corrected before the surgery can occur. Sometimes there are health problems you may have that make it too risky to have a transplant, so we try to determine these factors early. Kidney transplantation has many benefits, but it also has risks, so it is important not to cut corners in your evaluation. If transplantation is a safe and realistic option, we move on to the next step to the evaluation day. Prior to the evaluation day, you will receive a transplant program binder, the place to keep all important information for your transplant process. Bring your binder and transplant consent for evaluation form to your transplant appointment. Also, it is important to read the consent form before your appointment so you can discuss any concerns or questions with your doctors.
Most transplant donors and recipients come to Virginia Mason and are evaluated by the entire transplant team. During this busy day, there will be two evaluations. The first will be conducted by the nephrologist and the second by the transplant surgeon. For our recipients, there will also be a private financial discussion with a financial coordinator. All transplant candidates meet with one of our social workers and an education session with the transplant nurse coordinator. An appointment with a dietitian is available upon request.
Some patients who cannot travel here for an evaluation day have testing done by their local nephrologists, but it is best to have your records in our medical system when we need them at time of surgery. It is always important to keep your transplant binder with you as a reference during all evaluations.
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Most of the tests performed during your evaluation are familiar and routine: blood tests, an electrocardiogram (ECG), a chest x-ray and an ultrasound of the abdomen. We ask that you be sure to be up-to-date on cancer screening tests like colonoscopy, mammogram and pap-test (for women).
Recipient Advanced Screening
Routine screening may point out a need for further medical evaluation. Patients with known illnesses, such as a heart disease, will need updated testing. Heart problems are common in people with kidney failure. Often we need a cardiologist (heart specialist) to make an evaluation and assist us in the hospital. Even with the best testing, doctors, patients and families all need to be ready to cope with the possibility of an unexpected problem.
Consent for Evaluation Form
In your packet of information, you will find the Consent for Evaluation form. This form needs to be carefully reviewed and brought to the evaluation appointment. The transplant nurse coordinator will review the form and answer any questions. The form must be signed by both the potential transplant recipient and the nurse.
Conclusion of Screening Tests: Team Meeting and Activation
Before we move to the final pre-transplant lab tests, all of your information is assembled and the transplant team meets to discuss your results. You will be informed about the outcome of the team's review soon after we meet. There are three possible outcomes from the evaluation process:
- Accepted for transplant
- Deferred acceptance for additional testing
- Declined as a candidate
When you are accepted for transplant your financial coordinator will re-check your health insurance and request authorization when required. There are two options for a recipient to receive a transplant – living donor or deceased donor transplantation.
Living Donor Transplantation
If there is a donor, or several possible donors, blood tests are done with the blood of the recipient and donors. This is called lymphocyte crossmatching and can be done on multiple potential donors at a time. In this blood test, the donor's blood cells are tested against the recipient's to determine if the recipient has any previously formed sensitivity to that donor.
When there is a reaction between the cells, and the kidney would be rapidly rejected without aggressive desensitization, this is called a "positive crossmatch," and in most cases another donor must be found.
No reaction between the cells is a "negative crossmatch," meaning a transplant can safely take place. Once that negative crossmatch has been done, one donor is selected for medical evaluation. If this person is found to be a suitable donor from a medical, surgical and psychosocial standpoint, the operation is scheduled and a date is set for the transplant. This is preceded by a final preoperative evaluation the day before surgery.
Deceased Donor Transplantation
When no living donor is available, a recipient is placed on the deceased donor list. Once activated, we need to be able to reach you at any time of the day or night. It is very important for you to notify Virginia Mason of any changes to your contact information. A recipient must be ready at any time to come into Virginia Mason when a kidney becomes available.
Because there are so few deceased donor kidneys, we first try very hard to see if there may be someone in the recipient's life who wishes to donate. For a deceased donor transplant, special preliminary tests are done (HLA typing) to help find the right donor when the time comes. When a kidney becomes available, a final crossmatch must be done quickly a few hours before the transplant starts. This crossmatch must be negative for the surgery to take place. Usually, people waiting for a deceased donor transplant send tubes of blood to the lab every month, or every few months, so that this testing can be started quickly when a kidney is available.
If patients need to wait for an available kidney for over 12 months, we will schedule a repeat evaluation with the Virginia Mason transplant nephrologist to keep your information up to date.