Starting the Transplant Process
The first step towards receiving a kidney transplant is discussing transplantation with your personal physician or nephrologist (a kidney specialist). You can ask your physician or dialysis center to arrange an evaluation appointment with the Organ Transplant Program at Swedish. You can also make an appointment directly by calling or writing:
Swedish Medical Center
Organ Transplant Program
1124 Columbia St, Ste. 600
Seattle WA 98104
Phone: 206-386-3660 or 800-996-7426
Once we schedule your evaluation appointment, we will ask to have your medical records sent to us to be reviewed by our transplant surgeon and nephrologist. We will conduct a brief telephone interview to obtain your health-insurance information, emergency contacts and other important general information. We also will mail you a health questionnaire to complete prior to your appointment. You will be sent driving directions to our clinic and information about parking.
The Day of your Evaluation Appointment
Please ask a family member or close friend to accompany you to your appointment if possible. Your companion is welcome to remain with you throughout the appointment. You’ll be receiving a lot of new information, and he or she can help you ask questions and keep track of important details. Your family or friends will help take care of you after the transplant, so it is important to include them in the information-gathering process.
Your first visit will last approximately three hours. You will meet individually with a transplant surgeon, nephrologist, social worker and transplant nurse coordinator. Our goal is to help you understand what it means to get a kidney transplant. You will get to know us and learn about our approach to transplantation.
The transplant team will review your medical history and current health status to determine if transplantation is a safe and suitable treatment for you. During your initial appointment, we will discuss the following with you:
- Risks and benefits specific to your diagnosis
- Medical tests required for pre-transplant evaluation
- Donor options: living donor vs. deceased donor
- Transplant surgery
- Transplant medications
- Post-transplant recovery and follow-up
- Potential complications of the surgery or the transplant medications
- Concerns regarding the transplant's impact on your social or financial situation
- Other concerns or topics you wish to discuss
The potential transplant recipient undergoes an extensive pre-transplant medical evaluation. Some testing may be completed via your nephrologist prior to your first evaluation appointment, and the remainder of the tests can be done later. Testing includes, but is not limited to:
- A complete medical history and physical examination by a nephrologist
- Chest X-ray
- Heart test: Electrocardiogram or other more extensive testing of the heart
- Blood tests assessing your immune system, liver function and the presence of infectious diseases, such as HIV and hepatitis
- A complete gynecological examination for all female recipients and a mammogram for women 32 years and older
- Evaluation of the gastrointestinal system
- Blood typing, determining if you are O, A, B or AB blood type
- Tissue typing. This is another blood test that reveals the six genetic tissue codes that you were born with. (You inherit three codes from each parent.) This information is used in “matching” you to a possible cadaveric donor organ
For some, the evaluation can proceed very rapidly. For others, the process may take many weeks. For some patients, we will require more extensive testing due to your complicated medical history or other risk factors. You will be introduced to a transplant nurse coordinator who will communicate with you about the process of evaluation and who will arrange and/or monitor the tests and results. The coordinator is also an education resource for you and your family regarding the assessment and transplant process. To ensure that your workup will proceed as quickly as possible, we encourage your active participation in this process.
Approval for Transplant
Once your pre-transplant evaluation has been completed, the Organ Transplant team meets to discuss your transplant candidacy. The team includes Organ Transplant medical staff (surgeons, nephrologist, transplant coordinators and social worker), as well as nephrologists in the community affiliated with our program. If the team feels that it is medically safe for you to receive a transplant, you are ready to go on the deceased donor waiting list, or your living kidney donor’s medical evaluation can begin. You are encouraged to identify one person who will be available for a few weeks to support you and learn with you when you undergo the transplant procedure, whether you go on the waiting list or have a living donor.
Planning for Medical Expenses
Medicare is a medical insurance with benefits determined by the federal government. If you have permanent kidney failure (end-stage renal disease), you are eligible for Medicare benefits if you meet criteria for U.S. residency and work history. It doesn’t matter how old you are or what income you have. However, you can only purchase Medicare under the renal-disease rules if you have had a transplant or are on dialysis. Medicare benefits can help pay the costs of your kidney transplant at a Medicare-approved facility.
Medicare has two parts, Part A and Part B, and they offer different levels of benefits. You must be enrolled in Medicare at the time of the transplant in order to receive transplant-related benefits. For more information, contact the financial counselor at the Swedish Organ Transplant Program. You also may contact your local Social Security office and ask for the booklet titled “Medicare Coverage of Kidney Dialysis and Kidney Transplant Services," or you may go to www.Medicare.gov.
Employer or Individual Medical Insurance
In many cases, an insurance policy that is provided through an employer or purchased on an individual basis may be responsible for transplant costs. The vast majority of insurance plans pay for a transplant, as it is a standard (not experimental) medical treatment. At the time of your evaluation, our financial coordinator will discuss your insurance situation with you and go over the coverage your plan provides.
In most cases, Medicare and private insurance will not pay for a transplant completely. You should check into your own insurance benefits to determine hospital co-pays and prescription drug costs. As the number of medications that you will take after the transplant will be significant, it is especially important that you maintain a secondary insurance with prescription drug benefits.
When you get the call that a deceased donor organ is available for you, your transplant nurse coordinator will tell you when to come to the hospital. When you arrive at the hospital your blood will be drawn and you may have a chest X-ray and an EKG. A physician will examine you and review your medical history.
Your surgeon will again review with you and your family the transplant surgery and its risks, the medicines you will be taking and any research studies in which you have expressed an interest. You will then be asked to sign a form consenting to the operation.
Depending on the timing of your most recent dialysis and the results of your blood tests, you may need dialysis before going to surgery. The hospital transplant nursing staff will assist you with this and other preparations for the operation. Your final blood tests will take four to six hours to process before the transplant team receives the results, so you may be waiting for several hours in the hospital prior to the transplant. If your evaluation and testing indicate that everything is in order, you will be taken to the operating room.
If you are having a living-donor transplant, these tests, exams and discussions will be performed in the transplant clinic the week before your scheduled transplant date.
The kidney transplant surgery usually takes three to four hours. During the operation, the transplanted kidney is placed in the lower left or right side in the front of your body (in the area of your pelvis). The transplanted kidney is not placed near your original kidneys, which are located in the lower part of your back. Your original kidneys will remain undisturbed.
The artery that carries blood to the kidney is reconnected to a large artery in your pelvic area. The vein that removes blood from the kidney is connected to another large vein in the pelvic area. The ureter, the tube that carries urine away from the kidney, is connected to your bladder.
For a pancreas transplant, the blood vessels are connected in a similar manner. The pancreas is attached to your intestine for drainage of its secretions. A combined kidney-pancreas transplant surgery takes approximately 6 to 8 hours.
After the operation is complete, you will be taken to the recovery room. When awake and stable, a kidney transplant recipient returns to the transplant unit, while a kidney-pancreas transplant recipient goes to the Intensive Care Unit for a short stay. The surgeon will meet with your family after the surgery. Within a day or two after surgery, you will be encouraged to get out of bed and walk around the transplant unit. Transplant nurses will teach you how to care for yourself and your new organ.
Discharge and Outpatient Care
After discharge from the hospital, you will regularly visit the Organ Transplant Program outpatient clinic. At each clinic visit, you will have lab work (blood tests) to assess your kidney function, blood counts and level of immunosuppression. You will be seen by members of the transplant team which includes nephrologists, surgeons, nurse practioners, and transplant nurse coordinators. They will assess you for a variety of conditions. For example, they will examine you to ensure that your surgical incision is healing properly, that your blood pressure is well controlled, and that your immunosuppressive drug levels are appropriate.
During the first two weeks after you leave the hospital, you will come to the clinic two times a week. Clinic visits become less frequent in the following weeks and months. This schedule depends in part on your doctor’s preferences and how close you live to the transplant center. Since you will be restricted from driving for four weeks after surgery, you will need to arrange transportation to the clinic.
Out-of-the-area patients (those living one hour or more away from the hospital) are required to stay close to the hospital after discharge Out-of-state patients should be prepared to stay in Seattle for six to eight weeks following transplant. The Organ Transplant Program can offer financial assistance for housing as needed so that you can stay at a local apartment or hotel while receiving outpatient treatment.
The total transplant recovery period varies with each person and depends on your new organ’s function, the possibility of rejection, the amount of medication needed and complications. Most patients return to work about eight weeks after being discharged from the hospital. Your physician will make recommendations regarding activity level, when to resume exercising and when it is appropriate to return to work. Our social worker will be available to help you with issues related to returning to work or specific home situations.
Waiting for a Deceased Donor Kidney Transplant
When a person is accepted as a candidate for kidney transplantation, he or she is placed on the national waiting list. A person’s waiting time depends on a combination of factors that includes blood type, tissue type, antibody status and length of time on the waiting list. In the Pacific Northwest, patients with blood type O and B face longer wait times than the other blood types. Antibody status means the amount of human antigens that the patient has been exposed to and had a reaction. A patient may develop antibodies through blood transfusions, pregnancies or previous transplants making the waiting time for a transplant longer. The last factor, waiting time, means that the longer a person is on the list, the better the chance of receiving an organ.
After you are placed on the waiting list, you will be sent instructions on how to obtain a pager. Please inform us of any changes in your phone, pager or cell phone numbers so that we can quickly reach you. As the call for a deceased donor kidney can come at any time of day or night, it is important to keep your phone on at night so that you can hear the ringer and to carry your pager at all times. The transplant coordinator who calls you with an available organ will provide information on how quickly you need to come to the hospital and other instructions.
Keeping yourself in the best possible condition today will give you a better start on your new lifestyle with your new kidney. Preparing yourself both physically and emotionally can improve your recovery after a transplant. We encourage you to eat a "heart-healthy" diet, follow an exercise program, maintain good dental health care with regular checkups and take any medications or dialysis treatments prescribed by your doctor. It is essential that you refrain from smoking. The transplant team is available to help you get the support services you need. Stay in touch with the transplant coordinators and social worker or speak with the support-services staff in your dialysis unit.