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Before Transplant

Pretransplant Referral

Referring physicians, 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 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 pretransplant office and hospital business office will work with you to determine insurance availability and precertification requirements.
  3. Pretransplant 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 pretransplant initial testing, lab work (including tissue typing) and an array of clinical testing, education, surgeon interview and social work consultation (see Psychosocial Evaluation below) completed in one day.

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

  • Transplant nephrologist
  • Transplant surgeon
  • Pretransplant coordinator
  • Transplant clinical psychologist
  • Transplant social worker

Psychosocial Evaluation

Every patient being evaluated for kidney/pancreas 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

All patients must meet the chemical dependency requirements of the State of Ohio Solid Organ Transplant Consortium. The use of tobacco, alcohol and/or illicit drugs is carefully examined. Patients who meet criteria for alcohol or drug dependence must undergo at least three months of rehabilitation and demonstrate three months of abstinence before listing. If further chemical dependency evaluation is warranted it will be conducted by the clinical psychologist, Talbot Hall or another licensed facility.

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

After the psychosocial  evaluation is complete, a report is written and sent to the team with a recommendation about your suitability for transplant from a psychosocial perspective.

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 Medical Center, but depending on your geographic location or payer preference, they may be completed closer to your home.

Education

During the pretransplant 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.

You could be transferred, admitted or scheduled for a clinic visit within several days or three to four months.

A referral could be made to Cardiology, Pulmonary, Infectious Disease or other services as warranted.

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

Approval

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

If approved for transplant listing, the final step involves approval by the Ohio Solid Organ Transplantation Consortium (OSOTC). The OSOTC has a committee comprised of representatives from other transplant programs and other members who approve all patients for kidney/pancreas transplant listing in the state of Ohio. When approved by the OSOTC, you are then listed for kidney/pancreas transplantation on the UNOS national waiting list. A letter is sent to your insurance company providing recommendations for transplantation and requesting approval.

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/pancreas transplant:

Deceased donor organs: You may receive a donated kidney and pancreas 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 and pancreas from a deceased donor because, although the number of patients waiting for a kidney/pancreas transplant has increased dramatically, the number of available donor organs 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 and pancreas.

Living Donor organs: Usually, both the kidney and pancreas come from the same deceased donor. However, it's possible for a healthy person to donate one of his or her healthy kidneys while alive, and for the pancreas to come from a deceased donor. 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.

For more information, please view During Your Transplant.