The Kidney Transplant Process
What is the process to get a kidney transplant?
- Referral - Patients are referred to the PCH Transplant Center to be evaluated as a candidate for a kidney transplant.
- Consult Visit - Patients and their families meet with all of the kidney transplant team members to discuss the transplant process and assess candidate suitability. This sometimes takes place over two visits.
- Testing - This includes laboratory testing, x-rays, and sometimes visits with other specialists.
- Review - The entire kidney transplant team discusses the testing results and a decision is made to proceed to transplant.
- Schedule or List - A living donor transplant is scheduled or the patient's name is added to the waiting list for a deceased donor.
Who refers my child for transplant?
Your general pediatrician should refer you to a pediatric nephrologist for a consultation. The pediatric nephrologist knows when your child's condition requires a transplant.
Who is on the kidney transplant team?
Patient and Family - The patient and their family are the most important members of the team. Talk to other members of the team and make decisions together.
Pediatric Nephrologist - A pediatric nephrologist is a doctor who is trained to treat children who have kidney diseases.
Transplant Surgeon - A transplant surgeon is a doctor who does surgery to give people new organs, like kidneys.
Transplant Coordinator - A transplant coordinator is a nurse who works with children who have kidney disease and are getting ready for a transplant.
Renal Dietician - A renal dietician helps with special diets, formulas, tube feedings, or IV nutrition for children with kidney disease. Our renal dietician will also show you how to make healthy changes in your child's diet at home.
Social Worker - A social worker can help support you through the transplant evaluation and when your child is in the hospital. Social workers have advanced training as counselors and are good listeners. They work with the health care team to help you understand and deal with your child's illness. A social worker may connect you to groups and agencies in the community that can help you and your family.
Child Life Specialist - A child life specialist is trained in psychology and is available to meet with all patients. They help children and siblings understand the medical process in an age appropriate way. There is an in-house school for hospitalized patients, "1 Darn Cool School."
Financial Coordinator - A financial coordinator can help explain and work with your health insurance company to best help pay for your child's treatment.
How do you find out if the donor's kidney is right for my child?
Several blood tests need to be done to see if the donor's kidney is right for your child. This is called testing for compatibility.
The first blood test done is to check blood type. The donor's blood type and your child's blood type must be compatible.
This chart shows compatible blood types:
Recipient blood type:
Donor blood type must be:
A or O
B or O
A, B, AB, or O
Another blood test needed is called tissue typing. This test checks for Human Leukocyte Antigens or HLA. These antigens (proteins) are found on most cells in the body. We inherit them from our parents. Both recipient and donor antigens are checked to see how many they have in common.
A blood test called a cross-match is also done by mixing your blood with cells from a potential donor. This looks for antibodies that already are in the recipient. Antibodies kill substances that are in the body that don't belong there.
If the person getting the kidney has antibodies that will fight against the donor kidney, the kidney will be destroyed quickly.
What does the evaluation process include for the patient?
- History and physical - A pediatric nephrologist will review your child's medical history and perform a complete exam. The nephrologist will decide from this what testing and visits with other doctors may also be needed.
- Education visit - A transplant coordinator will meet with you and your family to talk about the transplant process in detail.
- Surgical evaluation - A transplant surgeon will meet with you and your family to talk about the transplant surgery.
- Dental evaluation - Children over 3 years old need to visit the dentist.
- Blood tests - Blood is tested for many things, including immunity against chicken pox, immunity to viruses, HIV, and hepatitis. Blood type and Human Leukocyte Antigens are also checked to start the matching process.
- Diagnostic tests -All patients need a chest x-ray (a radiographic picture of the chest) and an EKG or electrocardiogram (a graph of the heart's electrical currents).
- Immunizations – Your child's immunizations will need to be up to date prior to transplant. This is to reduce the risk of contracting a preventable disease when your child is receiving immunosuppressive drugs after the transplant.
- Nutritional assessment -The renal dietician will look at the state of your child's nourishment. The dietician will also work with your child diet after the transplant to make sure he or she is eating a healthy diet.
- Psychological and social assessment -The social worker will review the emotional side of having a transplant, and talk to you about financial issues.
- Financial review -The financial coordinator will ask you about your health insurance, and find out how much of the transplant costs the insurance company will cover.
- Decision-The transplant team reviews all this information and decides whether or not your child is ready to have a transplant.
What does the evaluation process include for the donor?
It is essential that any kidney donor receives a full evaluation prior to donation to avoid compromising the donor's health. This requires evaluation by an adult nephrologist, someone who is separate from the care and evaluation of your child. We have developed a partnership with local adult nephrologists to perform donor evaluations separate from our practice. This allows the evaluation teams involved to have each person's best interests in mind, to allow the best medical care for both donor and recipient. Most of the same tests will be performed on the donor as described above for the recipient.
What is the next step?
After your insurance company approves the transplant, the child's name is either added to the waiting list or a living transplant is scheduled.