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Before Transplant

Pre-Transplant Referral

Your primary care physician, a referring physician, dialysis centers, insurance case managers and other transplant centers can make a referral for a patient to be evaluated for transplantation appropriateness at Ohio State’s Wexner Medical Center. Here are some of the steps in the pretransplant referral process:

  1. The referring party is responsible for providing the coordinator with all applicable medical information according to the transplant referral protocol provided at time of referral.
  2. You will need to notify your insurance company before making your initial evaluation appointment. Our pre-transplant office and hospital business office will work with you to determine insurance availability and precertification requirements.
  3. Pre-transplant coordinators and business office staff then work together to meet insurance company requirements for evaluation and transplant procedure approval.

Evaluation

During your outpatient clinic evaluation visit, our goal is to have all the pre-transplant initial testing, lab work (including tissue typing) and an array of clinical testing, education, transplant doctor interview and social work consultation (see Psychosocial Evaluation below) completed in one day.

Following initial testing, the transplant team evaluates the information gathered and determines whether transplantation is appropriate. We will also determine what additional information is needed prior to placing you on the transplant list. These tests are customized based on your history and conditions, thus avoiding unnecessary testing and costs. It is preferred that these tests be completed at Ohio State’s Wexner Medical Center, but depending on your geographic location or payer preference, they may be completed closer to your home.

A referral could be made to cardiology, pulmonary, infectious disease or other services as warranted.

Once all of the testing is complete, a letter is also sent to your insurance company, with a copy of the pre-transplant patient chart, requesting precertification of the transplant procedure.

This patient evaluation is then reviewed at the weekly kidney transplant patient selection meeting attended by a multidisciplinary team to include:

  • Transplant nephrologist
  • Transplant surgeon
  • Transplant infectious diseases
  • Transplant clinical psychologist
  • Transplant social worker

Education

During the pre-transplant clinic visit, you will take part in a comprehensive education program that details the surgical procedure, medications, recovery and rehabilitation associated with the transplant process. The main focus is on educating you and your  family about the following:

  • Patients' responsibilities and role in the process
  • What happens clinically during surgery and recovery
  • Potential complications
  • Lifestyle modifications
  • Drug therapy
  • Cost factors
  • Support groups
  • Further evaluation

After your evaluation is complete, we will send follow-up letters to the referring physician and/or dialysis center, summarizing the pretransplant clinic visit and asking for any additional information required.

Psychosocial Evaluation

Every patient being evaluated for kidney transplant will have a psychosocial assessment with a social worker. The purpose of this evaluation is to help determine if a transplant candidate has the psychological stability, motivation and personal support to meet the challenges of transplantation. Before the appointment, you will complete a psychosocial survey that will be reviewed during the evaluation.

The assessment will cover:

  • Your insurance coverage and ability to afford surgical and medication expenses.
  • Your support system, (including primary and secondary caregivers)
  • Knowledge of the transplant process and  coping skills required to deal with the stress of the waiting period, hospitalization and recovery
  • Psychiatric history  including any current psychiatric problems
  • Track record of compliance with medical appointments and medications
  • Chemical dependency

Sometimes patients are referred to see a transplant psychologist, for further assessment of any psychological factors that may interfere with transplant outcome.

Approval

If  it is determined that you are an appropriate candidate for kidney transplant, you will be listed for kidney transplant with United Network for Organ Sharing (UNOS). In general, patients must have irreversible end-stage kidney disease with no medical or psychological/social contraindications.

If approved for transplant listing, a letter is sent to your insurance company providing recommendations for transplantation and requesting approval for transplant surgery, medications and follow-up care. Once approval is given, you are then listed for kidney transplantation on the UNOS national waiting list. A letter will be sent to you detailing your responsibilities while waiting for your transplant.

Tissue Typing

The Tissue Typing Laboratory assures that a graft is immunologically compatible with its recipient. The process involves matching a person's unique configuration of six human leukocyte antigen (HLA) molecules with a potential pool of approximately 100 different varieties.

Cross-match testing helps prevent hyperacute rejection. The testing involves mixing cells from the donor's and recipient's serum to determine whether rejection promoting antibodies will occur. If they do occur, you will not receive an organ from that particular donor.

Transplant support testing includes monitoring new drugs that patients use, testing to determine a patient's overall ability to maintain a graft, and developing new tests to support many of the clinical aspects of transplantation.

Waiting

There are two options that affect wait time for a kidney transplant:

Living Donor organs: The best option is when a healthy person agrees to donate one of his or her healthy kidneys while alive. Living donors do not have to be blood relatives of yours and can be spouses or friends. Wait times for patients who have living donors are greatly reduced from years to months and transplant recipients have better outcomes when the donor is living. We encourage all patients waiting for a kidney transplant to seek a living donor. (See Living Donations for more information)

Deceased donor organs: You may also receive a donated kidney from a person who has irreversible brain injury and who has previously registered to become an organ donor or the family wishes to donate. Please be prepared to wait as long as three-five years for a kidney from a deceased donor because, although the number of patients waiting for a kidney transplant has increased dramatically, the number of available donor kidneys has not. In addition, the donor must have a blood type compatible with your own and be similar in body weight and size. Each potential donor also must be screened very carefully for disease, infection or trauma to ensure that you receive a healthy kidney.

For more information, please view During Your Transplant.