Deceased Donor Transplant Planning

This is a general overview of standard procedure at many of the transplant centers in the United States. Each center may have a slight variation in their process, but this is a good basic explanation:

Cadaver Donor Transplant Planning

Waiting Time

When it has been decided that a living donor transplant is not possible for someone who wishes to have a kidney transplant, then the process of obtaining for a cadaver kidney begins. A cadaver kidney is a kidney that comes from someone who has recently died and whose family has consented to kidney donation.

When a cadaver transplant is planned, the recipient may need dialysis while waiting for the transplant. The waiting time can vary from months to years, depending on blood types. The average waiting time varies depending on blood type and location.

Monthly Antibody Screen

During the waiting time on the transplant list, blood tests are obtained every month. These are checked for antibody levels, which can change from month to month. It is necessary to have the "antibody screen" every month so that when a kidney is available we will have current blood samples needed for the final crossmatch. It is harder to find a kidney for people who have a high antibody level rather than a low antibody level. Therefore, people with a high antibody level (above 30%) will probably wait longer for a kidney. The blood sample is sent monthly from your dialysis center.

Matching Cadaver Kidneys to Recipients

Transplant programs participate in a national computer network which matches recipients and cadaver kidneys. This takes place through their procurement agency. Each time a kidney becomes available, its tissue type and blood type are entered into the computer and matched for the best possible recipient. The goal is to obtain the best possible match between kidneys and recipients regardless of location. As a result, a kidney for a transplant at your center can come from your home state or any other state.

Notifying the Recipient

When it has been found that a donated kidney matches a person on the transplant list, the procurement center is notified. The organ bank is ready to receive calls about kidneys 24 hours a day, 7 days a week. When a call comes in that a kidney is available, the transplant coordinator and the transplant surgeon on call are contacted. The transplant coordinator will then contact the patient. Because the call for a kidney may come at any time of the day or night and because an immediate answer is necessary in order to obtain the kidney, a person on the waiting list must have his mind made up that he is ready for a transplant. Sometimes someone has the flu or some other problem that would make it unwise from a medical standpoint to go ahead with the transplant. Therefore, the kidney is not actually accepted by the transplant team until they have asked the recipient if there have been any recent problems, infections, or blood transfusions.

Telephone Numbers of Recipients

Because the call for a kidney could come at any time of the day or night, it is essential that the transplant coordinator have any and all phone numbers where you might be reached (home, work, relatives, or any other numbers that might be helpful). Also, if you move, change telephone numbers, or will be out of town for prolonged periods, the transplant coordinator must be notified. It is the patient's responsibility to keep these phone numbers current. Sometimes they must accept the kidney within a certain time limit or it will go to someone else. If they cannot locate or talk to you, you could miss the chance for a transplant. They will not leave messages on answering machines because of time constraints.

Coming to the Hospital

When you are called and told that a kidney is available, you should have plans made to leave for the transplant hospital within an hour. You should not eat or drink before you come to the hospital because of the planned surgery. Please bring either a list of all your medicines or your medicine bottles with you to the hospital. Diabetic patients should bring their glucometers.

Final CrossMatch

When you arrive, you will be admitted to the hospital. Blood samples will be drawn. Sometimes a final crossmatch must be done between your blood, which is drawn when you come to the hospital, and a blood sample sent along with the kidney. This final crossmatch, which takes several hours, must show that there is compatibility between your blood cells and the donor's cells. At other times the crossmatch is done using the monthly blood samples that have been kept in the laboratory. In this case, the crossmatch may be completed before you get to the hospital. Either way, if the crossmatch shows incompatibility (positive cross-match), the transplant cannot take place and you will be sent home. The person with a high antibody level is more likely to have a positive crossmatch that shows incompatibility than the person with a low antibody level. If the crossmatch is negative and the patient is found to have no problems on physical exam, the transplant is done as soon as an operating room is available.

Back-Up Status

All transplant hospitals recognize the need to perform a transplant as soon as possible. For this reason, sometimes crossmatches are performed for more than one person at the same time. The people do not need to be in the same transplant center. This approach potentially shortens the time to transplant.

If more than one crossmatch is being performed, you may be called and told that there is a possibility that there is a kidney available on a back-up basis. This means that the kidney is a suitable match for you, but it is also suitable for someone else. Asking you to be a back-up depends on many things. The decision to ask someone to be a back-up is based upon the principles and federal regulations which govern the sharing and matching of kidneys, which gives each waiting recipient and transplant center fair and equal access to donated kidneys. You may be asked to come to the hospital as a back-up. If you do not receive the kidney, you will go home and wait for another call. If everything works out, they will go ahead with the transplant as soon as possible. If you are going to be asked to come to the hospital on a back-up basis, they will tell you this when they call.

Pre-Operative Preparation

When you get to the hospital, you will have a physical examination, electrocardiogram, chest x-ray, blood studies, and dialysis if needed. The examination, x-ray, and electrocardiogram are to determine that you are medically fit for the transplant surgery. Dialysis may be carried out so that your body chemistries are in good balance. A physician will visit you and will ask you to sign consent forms for the operation, the anesthesia, and for blood transfusions which may be needed during surgery.

While you are in the hospital, the transplant surgeons and nephrologist will both be taking care of you.

The transplant team may be conducting some research studies. You may be contacted by them in order to explain the study and to ask if you would be willing to participate. The willingness to participate in any study is a matter of personal choice, and you are free to say yes or no. When the operating room is available, you will be taken there and the transplant will be done.

You will not know the name of the donor of a cadaver kidney. The family of the donor will not be told your name by anyone in the transplant program. These rules are strictly enforced to maintain the privacy of both the donor family and the transplant recipient.