When should I be evaluated for kidney transplantation
All kidney failure patients should consider kidney transplant evaluation.
It is preferable to start evaluation long before starting dialysis. Transplant centers will initiate an evaluation for kidney transplant once kidney function drops to about 10-25% of normal function (stage 4 or 5 kidney failure).
How can I know if I am a candidate for kidney transplantation?
All patients with kidney failure should be considered for kidney transplantation.
Every transplant center has its own criteria for kidney transplantation.
In general eligible patients should be able to get around well and be able to perform normal daily activities, have no significant impairments in their thinking or memory abilities, have no major active infections, cancer or other major organ disease (heart, lung, liver, brain), and should have a reasonable life expectancy. Patients should not be actively smoking, using recreational drugs, or drinking heavily. Patients need adequate medical insurance. And, a patient should have good social support through family, friends, or paid caregivers.
Patients should also have a reasonable life expectancy for being eligible for kidney transplantation.
Due to longer waiting times for transplantation - having a living donor may allow a transplant center to consider patients who are older or those who have medical issues who would otherwise not be considered for deceased donor kidney transplantation because of the long waiting time.
Patients meet with a transplant team, comprised of multiple members (including physicians, nurses, social worker, pharmacist, financial representatives) who will determine the candidacy for living donor and deceased donor kidney transplantation.
How do I start transplant evaluation?
You can identify a transplant center through your kidney doctor, dialysis unit staff (nurse or social worker), or you can find the closest transplant center near your residence through transplantinterface.com or at www.unos.org.
You can ask your social worker or nurse to place a call for you to initiate a transplant evaluation or you may call the transplant center yourself, or for many centers even request information online, to begin a transplant evaluation.
Transplant centers will usually request basic information from you such as your name, address, social security number and insurance details.
They will obtain approval for an evaluation from your insurance company and will give you a date to come for a transplant evaluation.
What are the steps of a transplant evaluation?
Each transplant center is different in how they evaluate their patients.
Most of the centers will have a single day comprehensive visit including an introductory class about transplantation, followed by meetings with the doctors (transplant surgeon and a kidney doctor) and key transplant professionals (social worker, coordinator, dietician, pharmacist and financial expert).
Typically on the same day, patients will undergo blood and urine testing, chest X-ray and EKG. Based on a patient’s age and other medical conditions, a transplant center may request additional testing such as testing for the heart (ECHO, stress test, heart catheterization), ultrasound of the kidneys, colonoscopy, mammogram and Pap smear.
Some patients may require input from other specialists including dermatologists (skin), cardiologists (heart), pulmonologist (lung), hepatologist (liver) or neurologist (brain) specialists.
Most of the transplant centers will accept test results done previously at your local hospital.
These results will be compiled and discussed at a multidisciplinary meeting where members of the transplant team will determine if a patient should be approved for placement on the transplant waiting list.
Your transplant team will notify you once you have been added to the waiting list. If you are not a candidate, or require further testing to determine if you are a candiate, you will also be notified.
Where should I get, evaluated for listing?
Patients can be listed at one or more transplant centers. Many patients will choose to be listed at the center closest to where they live. Other factors such as insurance coverage or decisions based on waiting times and success rates may influence a patient’s decision.
Patients can be listed if % kidney function has been < 20 % at some point.