Please do not hesitate to ask your questions—however trivial they may seem to you. Every step of the way, your Transplant Coordinator will be available by telephone to answer any questions—and there is no such thing as a "silly" or "dumb" question. Please feel free to ask any questions, at any time, for any reason. We are here to help you.
Your Transplant Coordinator is available if you have any questions or concerns, and you may, of course, contact any member of the Kidney Transplant Team at any time with your questions.
The staff at the Kidney Transplant Center will answer all calls between 9 a.m. and 4 p.m., Monday through Friday, except holidays. The Transplant Coordinators will return these calls at their earliest convenience, usually the same day that you call. The Transplant Office number is 610-619-8420. Leave your name and telephone number where you can be reached. Try to be as specific as possible when you leave your message. Your call will be returned during the next business day. If you need to speak to a Transplant Coordinator during weekends, holidays or after hours, ask the answering service to page the Coordinator, who will return your call. If you have call block, please remember to remove it when expecting a call from our staff.
In the event of a life-threatening emergency, such as chest pain, coma, breathing problems, or bleeding, call 911 and they will take you to the nearest hospital emergency room. You and your family should always ask the physicians in the emergency department to call the Crozer-Keystone Kidney Transplant Center, but DO NOT try to drive to Crozer-Keystone in an emergency. Call 911.
Why do I need an evaluation?
The evaluation to determine your candidacy involves not only understanding your physical health but also understanding the psychological issues that may impact your ability to successfully handle a transplant. It involves considering your social situation and the ability of your friends and family to support you emotionally and logistically should you have any post-operative problems.
Why is that? It’s because Kidney Transplant Centers like Crozer-Keystone have a responsibility to assure that transplanted organs, which are so precious and difficult to come by, are placed with recipients who will benefit the most from receiving them. Crozer-Keystone takes this responsibility very seriously.
How do I request a Kidney Transplant Evaluation?
The evaluation process begins with a recommendation by your primary care physician and/or nephrologists for an evaluation by the Crozer-Keystone Kidney Transplant Team in order to determine if you are a good candidate for transplantation. With that recommendation, a letter requesting rather extensive preliminary information will be sent to you and your doctor to in order to understand your current medical condition. It is important to understand that the Transplant Team cannot evaluate you until we receive this information,
What does the evaluation and testing process include?
The following tests are given to all transplant candidates. Sometimes, there are additional tests specific to your personal health and care situation or based on any results of the testing that need further investigation. Some insurance policies require that you obtain referrals for each one of these tests. Be sure to obtain all necessary paperwork before you come in for these exams. Ask your Financial Coordinator if you have any questions about the paperwork.
- Physical Assessment: A physical exam and a complete medical and surgical history.
- Social Work Assessment: To discuss and determine your family/friend support before and after your transplant and to identify any additional resources that will be needed.
- Cardiac Stress Test: Shows how well your heart works under stress.
- Electrocardiogram (EKG or ECG): Evaluates the electrical system of the heart that controls rate and rhythm, and may reveal heart damage that was previously undetected.
- Echocardiogram: An ultrasound of the heart that will show how well your heart “pumps.” A scope is moved over your chest, creating a “view” of the internal structures of your heart by recording the sound wave (echo) obtained from beams of ultrasonic waves directed into the heart.
- Blood Tests: Many blood tests will be done during the evaluation period. Some of these tests provide us with information about your past exposure to specific viruses. This is useful in the management of your post-operative care. You will be asked to sign a consent for an HIV test. We will also verify your blood type and check your blood count and electrolytes.
- Chest X-ray: A radiographic picture of your lungs that determines the health of your lungs and lower respiratory tract and makes sure you don’t have any old infections that would get worse after transplant.
- Cardiac Catheterization:Depending on your condition and history, this test can be performed on either the right side of the heart or both the right and left sides. Medication is administered to numb the area where the catheter is inserted.
- Right Heart Catheterization-A catheter is inserted into a large vein and advanced into the right side of the heart. Pressures are measured in the pulmonary artery. This test helps assess the condition of your heart and lungs.
- Left Heart Catheterization-A catheter is inserted into a large artery and advanced towards the heart. A dye is injected into the blood vessels that supply the heart muscle. This test helps to see if there are any problems with blood supply to the heart.
- Colonoscopy: This test is required if you are 50 years of age or older. A scope (a long thin fiber optic tube with a lens on the end) in inserted into the colon to screen for cancer. If you have signs of cancer, you cannot be considered for transplant.
- Bladder Studies: An x-ray and/or camera examination of your bladder.
- Dental Evaluation: Your dentist must tell us that your teeth and gums are healthy before transplantation. You will also need to be checked by your dentist every year while you are waiting for your transplant.
- 24-Hour Urine Test: You will collect every drop of urine over a 24-hour period. This allows us to assess your kidney function.
- Panel Reactive Antibody (PRA): A way of determining whether you have antibodies that would cause you to reject certain kidneys.
- Tissue Typing: This test is used to find a matching organ.
- Nutrition Assessment: A dietitian will be available throughout the evaluation process as well as post transplant to help you plan a diet to keep you as healthy as possible.
- Mammogram: For female candidates, an x-ray of the breast used to detect and diagnose breast disease. If you have signs of cancer, you cannot be considered for transplant.
- PAP smear: A standard test that most women get at routine gynecological exams, cells from the cervix are examined to detect changes that may be cancerous or may lead to cancer and can show noncancerous conditions, such as infection or inflammation.
- PSA-Prostate-Specific Antigen: For male candidates, a test to identify the presence/level of a substance produced by the prostate that may be found in an increase amount in the blood of men who have prostate cancer, benign prostatic hyperplasia or infection/inflammation of the prostate.
How long is my evaluation appointment?
Your evaluation appointment will be four to six hours long. The evaluation process focuses on a variety of tests and analyses to determine if you are a good candidate for transplantation and if transplantation is truly the best and safest option for you. At your evaluation appointment, you will also learn more about kidney transplantation as a treatment option as well as the option of living donation.
What are the reasons why I would NOT be a good transplant candidate?
At Crozer-Keystone, all patients are considered potential candidates unless proven otherwise. Potential candidates should be well informed and demonstrate adequate health behavior and a willingness to adhere to guidelines from the Kidney Transplant Team as well as from other healthcare professionals.
Absolute contraindications to kidney transplant include, but are not limited to, the following:
- Any widespread or untreated cancer
- Significant mental impairment
- Medical unsuitability
The following are relative contraindications to kidney transplantation.
- Treated Malignancy: The cancer-free interval required will vary depending on the stage and type of cancer. Clearance by a board-certified oncologist is required in these cases.
- Substance Abuse: Evaluated on an individual, case-by-case basis.
- Chronic Liver Disease: Candidates with chronic hepatitis B or C or persistently abnormal liver function testing must have hepatology clearance prior to consideration.
- Heart Disease: All patients over the age of 50 with a history of diabetes must have a cardiac catheterization. Any patient with a history of a positive stress test or history of congestive heart failure must have cardiology clearance prior to consideration.
- Urology: For all patients with a structural genitourinary abnormality or recurrent urinary tract infection, urologic clearance is required prior to consideration.
- Mental health: Candidates who are psychiatrically unstable or adherence impaired as well as those with un resolvable psychosocial problems or the absence of a reliable or consistent social support system may be excluded from kidney transplantation.
- Aortoiliac Disease: Patients with abnormal femoral pulses or disabling claudication, rest pain or gangrene will require evaluation prior to consideration.
- HIV: Candidates who are HIV-positive are considered for transplantation on an individual basis.
- Age: Age is not an excluder for kidney transplantation. Candidates are evaluated on an individual basis.
Failure of any portion of the kidney evaluation could result in our inability to provide you with kidney transplant surgery. Every candidate is evaluated on an individual basis and all necessary actions will be taken to correct any abnormalities or issues that may arise.
How do you decide whether a potential donor kidney is right for me?
Several factors are considered when determining who will receive the available kidneys, including:
Blood Type: Every person is a blood type A, B, AB, or O. For deceased donors, the blood type must be the same. For living donors, the blood types must be compatible.
Tissue Type: Each of us has several genetic markers located on the surface of most of our white blood cells. One particular group of genetic markers is called HLA or Human Leukocyte Antigens (leukocyte refers to white cell and antigen refers to genetic marker). Tissue Typing is the name given to the test that identifies an individual's HLA. This information is critical before a patient receives a donor organ.
Certain antigens are used in choosing potential recipients and donated kidneys. In order to carry out tissue typing, a blood sample is drawn and the genetic markers on the blood cells are identified. Each marker has a letter and number in its name. For example, two common antigens are known as HLA-A1 and HLA-B8. Over 100 of these antigens have been identified. Some of the antigens are more common than others. A 6-antigen match is the best possible match for kidney transplants.
Cross Match: Your immune system may produce antibodies that act specifically against something in the donor's tissues. To see whether this is the case, a small sample of your blood will be mixed with a small sample of the donor's blood in a tube. If no reaction (negative crossmatch) occurs, you should be able to accept the kidney
If the available kidney matches up with you, and it is deemed healthy enough for transplant, we will begin your procedure as soon as possible.
When will I know whether I have been put on “The List?”
It can sometimes take several weeks for the results of your tests to come back and for your evaluation to be complete. When your pre-transplant evaluation is complete and all your results are received, the selection committee meets to determine if you are ready to be placed on the Transplant List—“The List.” If the transplant team determines that you are a candidate for a kidney transplant, additional testing or physician consultations may be required. We will let you know.
You will then have a meeting with your transplant team to discuss its decision regarding your eligibility. There is a tremendous amount of information discussed at this meeting, and you will have a lot to consider concerning your health and what is best for you. Ask as many questions as necessary. In fact, we encourage you to bring your family to this meeting so that everyone's questions can be answered.
Even if the team decides you are a good candidate for transplant, the final decision to proceed always rests with you.
How long is the waiting list?
Once you’ve been placed on the transplant list, you begin a period of waiting to be matched with a donor. Because there are many people waiting, and a serious shortage of donor organs, the waiting period can be quite long. It can range from several months to several years. There really is no way to predict how long your wait will be. There is no such thing as “the top of the list.” The order of the list changes with every kidney that becomes available and is dependent on blood type, tissue type and crossmatching results. The length of time you may wait will depend on your blood type and crossmatch reactivity to individual donors.
Of all the stages in the transplant process, the waiting period is perhaps the most challenging. For statistical averages of waiting times for each type of organ, visit www.unos.org.
What is Multiple Listing
Multiple Listing means that you are registered on the waiting list of more than one Transplant Center. It is possible that multiple listing may increase your chances of getting an organ offer earlier. Discuss this option with your Transplant Team. Ultimately, it is up to the specific Transplant Center to decide whether to accept you for multiple listing and it will most likely involve another full evaluation by their team. Check with your Insurance Company first to be sure that they will cover the additional testing.
Is there anything I should do while I’m waiting?
While you are waiting for your match is the perfect time to take care of a whole host of preparatory details. For example, develop a financial plan and a family support plan for when you are in the hospital and when you are recovering at home. Be sure to stay healthy and active. Talk to your team about diet, exercise and what you can do to stay as fit as possible. You should also pack a bag and prepare a plan for getting to the hospital and contacting family members. It is important to stay in close contact with your Transplant Team during this time. Be sure they are informed of any health changes because your health affects your ability to have a transplant. Let your Transplant Coordinator know about any trips you take out of town so the team will be able to locate you if an organ becomes available.
While you are on the waiting list you need to do the following:
- Attend our pre-transplant class – a schedule will be given to you
- Stay as healthy as you can
- Keep in touch with the Kidney Transplant Team
- Notify us of any telephone, address or insurance changes
- Have a small suitcase packed with toiletries, robe, slippers, etc.
- Contact the Kidney Transplant Team if you are going out of town, and where you can be reached
- Contact the Kidney Transplant Team if you have had a blood transfusion