Moving Closer to a Transplant

After the donor has completed all pre-transplant testing, the donor’s case will be discussed at the Organ Transplant Program’s medical review board meeting. The nephrologists, nurse coordinators, social worker and surgeons review the medical, psychological, social and financial information about the donor during this meeting. If there are no medical or psychological contraindications to donation, the donor will be approved to proceed to the two final tests: evaluation of the kidney blood vessels and a final crossmatch.

Evaluation of the blood vessels

The kidney’s blood vessels are studied to view the anatomy of the kidneys and to rule out any unsuspected disease or abnormalities. Testing also identifies which of the two kidneys would be more suitable for the transplant. There are two methods used for studying the blood vessels. One method is computed tomography (CT) angiography. For this highly sophisticated X-ray, a specialized dye is injected through a small vein in the donor’s arm and a CT scan is taken of the kidneys. This procedure takes about one hour to complete and does not require an overnight stay. There are no activity restrictions after the scan.

The other method of studying the kidney blood vessels is the renal arteriogram. A small tube is placed in the donor’s groin artery and advanced to the level of the kidneys. Dye is then injected through this tube into the kidney arteries to reveal the anatomy. Following the arteriogram, the donor must lie flat for five hours before being allowed to go home. Most donors find this the most uncomfortable part of the whole procedure.

The decision as to which test will be done is made by the transplant surgeons, and the choice will be discussed with you. The blood vessel study will take place at Swedish or in some cases, at a major medical center closer to the donor’s home.

Final blood testing and preadmission appointment

The final crossmatch is the last major blood test that needs to be completed. The donor’s blood cells and the recipient’s blood cells are combined and evaluated to make sure that the recipient has not created any antibodies that would attack the donated kidney. This test is performed during the final week before the transplant. A positive crossmatch means that the recipient has antibodies to the donor’s blood cells, predicting immediate failure of the transplant. A positive crossmatch will either rule out a specific donor or delay the possible transplant for further testing in the future. A negative crossmatch means that the transplant can proceed forward.

The final crossmatch is usually drawn during the donor’s preadmission appointment at Swedish. During this appointment, the donor will receive information about any surgical preparations needed and what to expect after surgery. The donor also undergoes additional blood and urine tests.