The transplant process begins with a referral. Your physician or dialysis unit can refer you to Ochsner's kidney transplant program by phone, fax, or mail. You may also call in to refer yourself. We will then contact you to gather initial information over the phone. Once it is determined that you may be a good candidate for transplant, your initial consultation appointments are scheduled.
The evaluation process involves an initial medical workup, which will include consultations, lab tests and various procedures to determine the medical appropriateness of kidney transplant. For you initial appointments, you will have a consultation with a Transplant Nephrologist or a Physician Extender, a physician who specializes in kidney disease. You will also meet with a Social Worker to evaluate your ability to cope with the stress of transplantation and your ability to follow a rigorous treatment plan, both before and after transplantation. The social worker will also help to identify your support network. A Financial Coordinator will discuss the costs associated with your transplant and with the medications you will require after transplant. They will work with you to help you understand your insurance coverage. It is important that you understand the costs that may not be covered by insurance. Once your initial appointments have been completed, you will be scheduled for more in-depth medical tests.
During the work-up phase, you will meet with the Transplant Coordinator who will provide education regarding the transplant evaluation process, the listing process, and patient responsibilities before and after transplant. A Transplant Surgeon will also meet with you and discuss the appropriateness of a transplant based on the information obtained during your evaluation. The surgeon will also discuss the significance of undertaking a kidney transplant, the various types of kidneys available, the risks of the surgery, and the possible complications after your transplant. Many different tests are done to determine if you are a suitable transplant recipient.
The following tests will be included in your evaluation process. Remember, other tests may need to be done based on the results of these tests or on your medical history.
- Laboratory studies
- Diagnostic Tests including but not limited to: Chest X-ray, EKG, TB Skin Test, Renal Ultrasound, CT Scan of Abdomen, Cardiac Stress Test
- Gynecological exam and PAP smear for females
- Mammogram for women over 35 year of age
- Colonoscopy for patients over 50 years of age
- Consults with other specialists including Infectious Disease to ensure updated vaccines
Once all medical tests have been completed, your case is presented in front of a committee to discuss your eligibility for a transplant. If it is decided that you meet the requirements, you will be placed on the list for transplant. The median waitlist time for kidney recipients on our waitlist is 452 days, much less than the national average of 1265 days. During your waiting time, you will be required to come in every six months to one year to meet with a physician and have updated testing. You will be required to send in a monthly blood sample to be tested for compatibility with any donors that may be available. Either you or your dialysis unit will need to send this blood to us every month.
When a donor organ becomes available, you will be called and evaluated to decide if you are suitable for transplant at that time. A blood test will then be performed to determine if you are a match with this particular organ. It is at this time you will be asked to come to the hospital for the transplant operation. During the transplant surgery you will be put under general anesthesia, which means you will be given medications to put you to sleep, block pain and paralyze parts of your body. You will also be placed on a machine to help you breathe. As with any major surgery, there are risks involved. The surgeon will explain the risks of surgery to you. After the surgery you will be taken to the Transplant Stepdown Unit or ICU as your status permits. Immediately following the surgery, you will experience pain. This will be carefully monitored and controlled. Most transplant recipients have a significant reduction in the pain in the first week after surgery. Your length of stay in the hospital will depend on the rate of your recovery. You will remain in the hospital as long as your physicians feel hospitalization is necessary. Most patients stay in the hospital for approximately three to seven days. The hospitalization time can vary depending on the severity of your illness prior to transplant or complications after surgery.
After you leave the hospital you will still be recovering. For the first six weeks you will have some restrictions on your daily activities. During the recovery period the transplant team will follow your progress. You will need to be monitored on a long-term basis and you must make yourself available for examinations, laboratory tests and scans of your abdomen to see how well your transplanted kidney and/or pancreas is working. If you do not live locally, you will be assisted by a transplant Social Worker to obtain local affordable housing for a period of one to four weeks post-transplant or until you are medically stable to go home. The transplant team will see you regularly for three months post transplant. Every effort is made to transition your routine medical care to your primary care physician. You will be followed in the transplant clinic for life. For most patients this involves frequent lab work and a yearly clinic visit. You will also continue to follow up with your regular doctors.