"Inside the Kidney Transplant Evaluation: What You Need to Know"

Upon initially undergoing a kidney transplant evaluation, I was uncertain of what lay ahead. I knew it would entail a multitude of tests and blood draws, and that the hospital's chill would warrant a jacket. However, beyond these rudimentary details, I found myself utterly unprepared. Now, having navigated the process personally, I am keen to share my experiences with others who may be on the threshold of this journey. Feel free to contribute your own experiences in the comments below.

My evaluation took place at a hospital located in a different state from where I reside; hence, there were several online appointments before my three-day visit for the completion of necessary testing. If your designated hospital is local, your appointments will probably be face-to-face. Here's an abridged overview of what you can anticipate:

1. Referral

Your doctor or dialysis center will refer you to a transplant hospital. You can expect to hear back from the hospital and schedule your appointment within 6 to 12 weeks; however, some hospitals may require up to six months. If worried about not receiving feedback from a referral, consult with your doctor or dialysis nurse who can verify your status.

2. Scheduling and Financial/Insurance Review

An insurance coordinator will review your coverage and discuss any potential out-of-pocket expenses with you. A financial counselor will also assist in planning costs associated with the transplant, including medication and follow-up care costs. Finally, a scheduler will aid in arranging all necessary appointments and tests.

3. Initial Consultation

• Medical History and Physical Exam: Your previous medical history encompassing surgeries, illnesses, and medications will be meticulously reviewed followed by a physical examination.

• Psychosocial Evaluation: You'll meet with a social worker or psychologist to discuss mental and emotional preparedness for the transplant procedure.

• Social Worker Evaluations: to evaluate your support system’s robustness and ability to comply with your pre and post-transplant care regimen.

4. Pre-Transplant Education

• Transplant Team Meeting: The transplant team will provide an overview of the transplant process, and expectations before, during, and after surgery, and emphasize the significance of adhering to medication instructions.

• Nephrologist and Surgeon: The nephrologist and surgeon will discuss the surgical procedure with you, including any associated risks and benefits. They will also explain the necessary immunosuppressive medications that must be taken post-transplant.

• Dietitian Consultation: A dietitian will provide advice on maintaining a nutritious diet to prepare your body for the transplant procedure and ensure good health thereafter.

• Live Donor Education: If considering a live donor, this session will elucidate how they can expedite finding a donor and offer guidance on initiating the search.

5. Diagnostic Testing

• Blood Tests: Blood tests will be performed to confirm your blood type and tissue

• typing as well as check for any infections or conditions that could affect the transplant.

• Imaging Tests: These may include chest X-rays, CT scans, or MRIs to evaluate your organs' health and ascertain there are no conditions that could complicate surgery.

• Heart and Lung Function Tests: Various tests such as EKGs, echocardiograms, and stress tests will be conducted to certify that your heart and lungs are robust enough for the transplant operation.

Note: Please carefully read all instructions as there are strict dietary restrictions and limitations on medication usage before undergoing these tests.

6. Specialist Evaluations

Should you possess any existing health conditions or concerns, it may be necessary to consult with additional specialists. For those with a history of cardiac issues, clearance from a cardiologist might also be required.

7. Hospital Transplant Committee Review

Once all testing and other standard requirements such as annual physical examinations and dental check-ups are completed, your information is compiled and forwarded to a transplant committee at the hospital. The doctors on this committee will review your information and determine your status. This procedure can span several weeks depending on the frequency of team meetings.

8. Approval

The approval or denial process begins with individuals meeting all criteria and passing diagnostic tests, which include weight (BMI) requirements and psychological evaluations.

Each transplant center has its own set of prerequisites that must be fulfilled for an individual to receive approval or face rejection. If one hospital denies an individual, there remains the possibility of acceptance at another institution. This was my personal experience; my first hospital rejected me, but I received approval from the second.

There are three possible outcomes:

• Acceptance - You will be placed on the wait list for a transplant.

• Conditional Acceptance - You may need to complete specific tasks before being placed on the wait list. Your placement could potentially be delayed until these tasks are finished, based on various factors.

• Denial - You are deemed ineligible for a transplant. If this occurs, it's crucial to inquire why you were refused and consider applying at a different transplant hospital where that reason may not apply. For instance, if BMI was the cause for rejection, try seeking out a hospital with higher BMI allowances before abandoning hope for a transplant entirely.

My evaluation at my current hospital from step 1 to approval step 8 spanned over nine months.

9. The Wait List

Upon approval, you join the United Network for Organ Sharing (UNOS) list where you await a donor's kidney. The duration spent on this list can vary significantly based on factors such as blood type, geographic location, and personal health.

Some people wait between three to five years, while others may endure a decade or more. Individuals with blood type O typically wait the longest as they can only receive a kidney from a donor of the same blood type.

Here are some examples of potential wait times:

Blood Type	Average Wait Time by State
	A	B	AB	O
California	3 to 5 Years	3 to 5 Years	3 to 5 Years	7 to 10+ years
Arizona	2 to 4 Years	2 to 4 Years	2 to 4 Years	4 to 6 Years
New York	4 to 6 Years	4 to 6 Years	2 to 4 Years	5 to 7+ Years
Utah	2 to 4 Years	3 to 5 Years	1.5 to 3 Years	2 to 4 Years

As you can see, regional availability, high demand, and population density can influence waiting periods. Please note these figures are current as of June 2024 and are subject to change.

 A Way to Reduce Your Wait Time

You can significantly reduce your waiting time by having a potential living donor. Even if they're not a blood type match for you, they can still donate through a paired exchange. I will elaborate more on this in my upcoming living donor blog.

10. Continuous Monitoring

While awaiting your transplant, your health will be regularly monitored including monthly blood draws.

11. Annual Evaluations

 You will be required to undergo tests to ensure that you remain eligible for transplantation; however, the number of required tests will be significantly fewer than before. It's important to maintain good health during this period to retain eligibility.

12. Be Ready

Instructions on how to prepare for surgery once a donor's kidney becomes available include ensuring that you have a bag packed and ready at all times—you could receive your life-changing call at any moment.