The Transplant Evaluation
The first step in the transplantation process is your Evaluation Appointment. 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.
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. At your evaluation appointment, you will also learn more about kidney transplantation as a treatment option and how it will fit into your life.
Throughout this evaluation, you’ll find yourself taking many tests. These tests will help determine if transplantation is truly the best and safest option for you. During this process, your Transplant Coordinator will also discuss the option of living donation.
Transplant Evaluation Exams
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.
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.
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.
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.
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.
Depending on your condition and history, this test can be performed on either side of the heart on 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.
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, this may need to be addressed before you can be considered for transplant.
An x-ray and/or camera examination of your bladder.
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 tests characteristics about your tissues. Cross-matching is then done to determine if a prospective donor and recipient are compatible for transplantation.
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.
For female candidates, an x-ray of the breast used to detect and diagnose breast disease. If you have signs of cancer, this must be addressed before you are considered for transplant.
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.
For male candidates, a test to identify the presence/level of a substance produced by the prostate that may be found in an increased amount in the blood of men who have prostate cancer, benign prostatic hyperplasia or infection/inflammation of the prostate.
Candidate Selection Criteria
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 exclusion for kidney transplantation. Candidates are evaluated on an individual basis.
What Happens Next?
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. Your Transplant Coordinator 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 rests with you. If you are recommended as a candidate it is important that you quickly finish all the requirements necessary to be registered on the national organ transplant waiting list. You do not want to miss an opportunity to receive an organ simply because your paperwork is not finished.