Kidney Transplant Surgery

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  • Thanks ringer21 for the post. we should be aware of kidney diseases, their causes, symptoms, treatment and prevention. About 66% of kidney failures are said to be due to diabetes and hypertension, and in India about 25 to 40% of the population is said to be at risk to chronic kidney disease (CKD) and end-stage renal disease (ESRD). Fortis Urology one of the best medical centre for Kidney Transplant Surgery in India.
    http://www.fortisurology.com
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Kidney Transplant Surgery

  1. 1. News: Mom gets dual-transplant from her children Submit Search this site: The Kidney Transplant Program at USC University Hospital is dedicated to providing comprehensive perioperative care to patients with chronic renal disease, including end-stage renal disease. Our team consists of physician and surgeon specialists and nurse coordinators whose purpose is the efficient pre-transplant evaluation and management and a smooth transition into the transplant phase. Following kidney transplantion, care will be coordinated by the USC nurse transplant coordinator and depends on consistent communication between the transplant physicians, the patient, and the referring doctor. Within the scope of our program exist the necessary services to provide comprehensive evaluation and management of patients before and after the transplant event. The kidney transplant procedure is performed at the USC University Hospital. The USC University Hospital, opened in 1991, is a modern 284-bed hospital on the USC Health Sciences Campus near downtown Los Angeles. The Kidney Transplant Program is one component of the full-service Multi-Organ Transplantation Program at the University of Southern California School of Medicine. One legacy program also performs transplants of heart, lung, liver, and bone marrow. We are affiliated with the Southern California Organ Procurement Center (SCOPC), an agency that has been ranked in the top five of 69 organ procurement agencies throughout the nation for quality and efficiency of organ retrieval. Additionally, all of our transplant programs are members of the United Network of Organ Sharing (UNOS), which is the central agency in the United States whic is
  2. 2. responsible for equitable allocation of organs. These affiliations provide our patients with the best opportunities to receive new organs. Since the first kidney transplant was performed at USC University Hospital in October 1991, more than 250 have been done, with an average 92% patient survival rate and 87% graft survival rate at three years post-transplant -- statistics well above the UNOS national averages. Full Scope of Services Expanded surgical techniques, improved anti-rejection protocols, and high-quality patient care characterize the USC program and are critical factors in our current success in kidney transplantation. Candidates for kidney transplantation are individuals with chronic kidney failure related to: q diabetes q hypertension q glomerulonephritis (chronic kidney inflammation with failure). q polycystic kidneys q other kidney diseases Patients have convenient access to a range of comprehensive services, including: q A Full-Service Dialysis Center - Located on the USC medical campus next to the University Hospital, the dialysis center is a new facility that offers dialysis in a comfortable environment. q Access Management - Physicians, nurse specialists, and ancillary personnel have the capability of establishing reliable dialysis access including fistulas, grafts, and peritoneal catheters. In addition, we have the surgical and interventional radiologic skills to troubleshoot and manage difficult access problems, including clotted access, graft revision, and catheter infections. q Cadaveric Transplantation - Cadaver organs are acquired based on criteria set forth by UNOS. Working with SCOPC, the USC team is able to implant allocated organs within 24 hours. q Living Donor Transplantation - Live donor transplantation has become increasingly common, due in large part to the success of the procedure and the shortage of cadaveric organs. Living donation allows the immediate transplantation of kidneys into recipients so operations can be scheduled electively once a suitable living donor has been identified. This avoids the long waiting times encountered with cadaveric donation. The USC University Hospital program has earned an outstanding reputation for its living donor program and now offers a new minimally invasive approach to living donor nephrectomy (see laparoscopic kidney removal below). q Followup Care - Our physicians are practiced in the use of the latest immunosuppressive drugs, including a new class of specific antibodies to some of the cellular receptors responsible for rejection. These FDA-approved drugs have reduced the frequency of rejection episodes by about 40 percent. Laparoscopic Kidney Removal One of the newest and most advanced procedures offered by the USC Kidney Transplant Program is laparoscopic kidney removal from living donors. In this minimally invasive approach, four or more small incisions are made in the abdominal wall. Video equipment and instruments are inserted through these punctures to visualize, dissect, clip, and staple. Once the kidney is freed from its
  3. 3. attachments, it is extracted from the abdomen through a 3-inch supra-pubic incision, and cooled. It is then prepared for immediate implantation into the recipient, following the donor surgery. This minimally invasive procedure results in less pain, a reduction in hospitalization from five days to one or two days and a return to normal activity in about a week for the donor. Family Involvement Kidney transplantation is a family affair, especially if the recipient is receiving a kidney donation from a living relative. For this reason, family members are intricately involved in the care process, including decision making and follow-up lifestyle changes. The USC transplant coordinators help kidney patients and their families communicate and learn about what is happening. They are available 24 hours a day to answer emergency questions. They also serve as liaisons among patients, referring physicians, and the USC kidney transplant team. Through their commitment and dedication, patients and family members experience a true continuity of care from admission into the program through post-transplant follow-up. A Dedication to Education The Kidney Transplant Program at USC University Hospital is dedicated to both patient and physician education. We provide continuing medical education for outside physicians and dialysis center staff by providing conferences on topics related to pre-transplant and post-transplant management issues, maintain a web site for patient and physician access (kidneytransplant.org), host a monthly transplant support group for abdominal organ transplant candidates and recipients (to be announced), and a yearly physician symposium to discuss cutting-edge issues in kidney transplantation. Patient Education The complexity of kidney transplantation requires intensive education for patients, living donors (if applicable), and family members. The program has produced brochures in English and Spanish regarding all aspects of the transplant process. In addition, recipients and donors receive extensive one-on-one instruction and education by members of the multidisciplinary transplant team. A patient support group for transplant patients is also held on a regular basis, helping recipients find strength and encouragement through the experiences of others. Physician Education Members of the Kidney Transplant Program are regularly invited to local and national meetings to discuss the latest advances in the field of end-stage renal disease and kidney transplantation. They also speak to local groups of physicians and hold Grand Rounds across the Southland. In addition, our physicians are available for telephone consultations and invite colleagues to call with questions about complex cases. For More Information There are several ways to obtain more information about this program or to make a referral: q Visit our contact information page, or phone Kidney Transplant Program Administrator Brad Selby at (323) 442-5908. q Call 1-800-USC-CARE and ask for information about the Kidney Transplant Program. q Visit our Patient's Guide to Kidney Transplant Surgery Web Site.
  4. 4. USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu Copyright © USC Kidney Transplant Program. This Web site was developed in 1999 as a service provided by the USC Kidney Transplant Program. This Web site provides selected information available about kidney transplantation which may become out of date over time. It is important that consumers see a healthcare professional for detailed information about medical conditions and treatment. This information is not intended to be a substitute for the advice of a healthcare professional, or a recommendation for any particular treatment plan. The USC Kidney Transplant Program has made and will continue to make efforts to include accurate and up-to-date information on this Web site.
  5. 5. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Conventional Kidney Quality Care in a University Setting Transplant At USC University Hospital and the USC/Norris Comprehensive Kidney-Pancreas Transplant Cancer Center and Hospital, we are committed to offering patients a Pancreas Transplant choice in their care. We understand that many patients choose not to Information for Patients accept blood products, and we respectfully accommodate this choice. Transplant Patient Guide Our Transfusion-Free Medicine and Surgery Program is designed to About the USC meet the individual needs of patients who do not wish to receive blood University Hospital transfusions. In our academically based program at the University of Financial Considerations Southern California School of Medicine, physicians and surgeons from Kidney Glossary many disciplines perform innovative techniques that minimize blood loss, thereby avoiding the need for blood products including red blood Features cells, platelets and plasma. What's New Kidney Research Transfusion-Free Medicine & Surgery requires special and Development expertise--expertise that is found at the Keck School of Medicine of USC. Calendar of Events Kidney Newsletter All of the physicians and surgeons who participate in the Downloads Transfusion-Free Medicine & Surgery Program are USC faculty members, offering advanced tertiary/quaternary care. Patients benefit General Information directly from the academic affiliation, receiving access to the latest Faculty and Staff medical advances. Contact Information Web Links Advanced Skills and Technology Site Map Alternatives to blood transfusions have been made possible through Search this site advances in medical and surgical techniques and technology. Blood loss can be minimized through: q Using lasers rather than scalpels. Submit q Stimulating bone marrow to produce red blood cells in advance of a procedure. q Enhancing circulation of the patient's own blood during surgery through volume expanders or intravenous fluids. q Tracking oxygen levels during surgery with skin monitors. q Using cellsavers during surgery to collect, recirculate and readminister the patient's own blood.Speeding blood clotting during surgery with an argon beam coagulator. q Utilizing intraoperative hypotension anesthesia to lower blood pressure during surgery, minimizing bleeding. Participating Medical and Surgical Specialties
  6. 6. The medical staff at both USC University Hospital and the Norris Comprehensive Cancer Center and Hospital are faculty of the USC School of Medicine. Many of them are recognized as international leaders in their fields who provide tertiary/quaternary medical and surgical services for patients from around the world. With Dignity and Respect In just three short years, Nicolas Jabbour, M.D. and Randy Henderson have taken the USC Transfusion-Free Medicine and Surgery Program from an intriguing idea to one of the most well-recognized centers in the country. Through his experience with patients who do not want to take blood products, Jabbour says he has not only obtained a deeper understanding of the religious beliefs of some patients but has also come to ardently believe in the importance of minimizing blood loss for all patients, at all times. "When I meet a Jehovah's Witness patient, or any individual who does not want blood products," says Jabbour, "I see my job as not to convince them to receive blood but rather to find a way to treat them with dignity and a profound respect for their beliefs. Our program tries to provide the best possible care within our limitations--and to turn those limitations into surgical and therapeutic challenges instead." USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  7. 7. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Conventional Kidney Transplant Kidney-Pancreas Transplant Pancreas Transplant What is Laparoscopic Surgery? View a Laparoscopic Information for Patients Left Donor Nephrectomy Transplant Patient Guide Laparoscopic surgery is RealVideo movie, approx. 10 minutes About the USC performed by inflating the abdomen with gas, usually University Hospital carbon dioxide, which creates a Financial Considerations space between the wall of the Kidney Glossary abdomen and the organs inside. Features Using short incisions in the skin, What's New narrow tubes are inserted Kidney Research through the abdominal wall so and Development that instruments can be slid Calendar of Events Can't view the video? through them to perform the maneuvers necessary for the Click here to download Kidney Newsletter a free RealPlayer Downloads operation. All this is viewed directly on a video monitor which General Information receives its picture from a video Faculty and Staff camera attached to the laparoscope. Contact Information Using these techniques, operation on the gallbladder, stomach, intestines, Web Links kidney, and other organs is possible. Site Map Search this site Laparoscopic Kidney Removal Using narrow instruments inserted through tiny punctures no more than a Submit ½ inch long it is now possible for the surgeon to free up the kidney and tie off the blood vessels. A short incision about 2 ½ inches long is made to remove the kidney. The site on the abdominal wall depends on the kidney to be donated because the donor is positioned on the operating table with the chosen kidney uppermost (see diagram below). The place is selected for cosmetic considerations and reduced disturbance to the muscles underneath in order to minimize pain.
  8. 8. The Operation
  9. 9. Four or five tiny incisions are made in the abdominal wall for the video equipment and instruments to dissect, insert metal clips, staples or tie knots, and remove the kidney from its attachments. A blood thinning drug (heparin) is given to prevent blood clotting in the kidney after it is removed. The kidney is scooped up in a bag and extracted from the abdomen through a short incision (5 in above diagram) and chilled on ice. It is then prepared for immediate implantation into the recipient who will already be anesthetized in an adjoining operating room. Drugs are given to make the kidney excrete large volumes of urine just before removal so a catheter is left in the bladder to measure the urine output and keep you comfortable. It is usually removed within a few days. Benefits to the Donor The advantages of laparoscopic surgery come from minimizing the trauma of access to internal organs. By avoiding a long incision through the muscles, many post-operative problems are eliminated and pain is markedly reduced. This enables the donor to breathe and cough better. Use of strong pain medications is drastically reduced so the drowsiness, fatigue and unsteadiness they cause is minimized. Risks for the Donor All operations carry some risk. Those which are the most important for you to know about are mentioned here. Most of the complicated laparoscopic procedures which we perform require full general anesthesia to allow enough relaxation of the muscles of the abdominal wall so that the operative space to work in is large enough. Modern anesthesia is very safe and the anesthesiologists at USC are all highly skilled, board certified physicians. Naturally they will need to be fully informed of any medical disorders that you may have or problems with anesthesia in the past. It is especially important that if you have any heart problems, your regular physician can send copies of old EKGs and information about any other tests that you may have had. Any operation can be complicated by bleeding and infection. If an operation has been performed through a large incision, a hernia (or muscle defect) can develop in the wound days, months or years later. Thrombosis and pulmonary embolus (clots to the lungs) are an ever present risk. It has been our experience that these complications are much less frequent after laparoscopic than conventional surgery. Even in traditional surgery, each operation has a specific complication that every surgeon strives to avoid. These potential pitfalls are still present when the operation is performed laparoscopically and will be outlined to you, depending on the type of procedure you require. Occasionally, difficulties are encountered during surgery that cannot be safely managed laparoscopically. This may be suspected before the operation and confirmed with the laparoscope. If so, conversion to a conventional open procedure is for your safety. Alternatives Most live donors come to us for laparoscopic surgery, although we have an extensive background in traditional surgery. Much of the discussion of
  10. 10. alternative forms of treatment will have taken place before coming to see us. If we feel that your best interests will not be served by laparoscopic surgery we will tell you so and suggest an appropriate alternative. Complications It is rare for there to be problems due to the surgery. Bleeding during or after surgery is the chief complication and is minimized by careful technique. Low blood pressure and faintness may be signs of bleeding and should be evaluated by the surgical team. Because the operation is performed alongside other organs it is theoretically possible that an injury could occur to one of them. Persistent pain, fever, nausea or vomiting should be notified to the surgeon. Admission and Discharge Admission takes place two hours before the planned procedure. The donor operation takes 3-4 hours and the recipient operation lasts about 2 hours. In addition, the time necessary for anesthesia before and after operation may be 30-60 minutes. We will call your waiting relatives as soon as the surgery is finished to report on your progress. You will be allowed to drink a few hours after you wake up and will start light foods the next day. The area of the kidney often slows normal bowel function so return to a normal diet must be cautious. You may be able to go home the next day, or the day after depending on how comfortable you are. Related links: q Conventional Kidney Transplant USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  11. 11. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Conventional Kidney Regular donor nephrectomy requires a long incision with removal of a Transplant rib, to allow the surgeon access to the kidney, blood vessels and Kidney-Pancreas Transplant ureter. Hospitalization of about 5 days is necessary. Nonetheless, this operation has been performed thousands of times, providing a safe, Pancreas Transplant reliable way of removing the donated kidney. Information for Patients Transplant Patient Guide About the USC University Hospital Financial Considerations Kidney Glossary Features What's New Kidney Research and Development Calendar of Events Kidney Newsletter Downloads General Information Faculty and Staff Contact Information Web Links Site Map Search this site Submit The new kidney is placed low in the right or left groin area. Diseased kidneys are not removed unless necessary. Complications Wound infection is the most common complication other than the procedure, and can usually be treated as an outpatient. Because the operation is performed alongside other organs it is theoretically possible that an injury could occur to one of them. Persistent pain, fever, nausea or vomiting should be reported to the surgeon. Admission and Discharge
  12. 12. Admission takes place two hours before the operation. The operation takes about 3-4 hours. In addition, the time necessary for anesthesia before and after the surgery may be 30-60 minutes. We will call your waiting relatives as soon as the surgery is finished to report on your progress. You will be allowed to drink a few hours after you wake up and will start light foods the next day. The area of the kidney often slows normal bowel function so return to a normal diet must be cautious. You may be able to go home after 2-3 days, depending on how comfortable you are. Related links: q Live-Donor Laparoscopic Kidney Transplant USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  13. 13. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Conventional Kidney Some clinical studies have shown that diabetic patients undergoing Transplant kidney transplantation alone have a lower graft survival when compared with diabetic patients undergoing kidney and pancreas Kidney-Pancreas Transplant transplant procedures together. It is customary in most centers to Pancreas Transplant transplant both kidney and pancreas together from the same donor. Information for Patients Monitoring is then done for the rejection episodes of both organs via Transplant Patient Guide the kidney graft. Most patients enjoying a normal life away from dialysis and threat of hypoglycemic or hyperglycemic episodes. About the USC University Hospital The operative procedure takes approximately five to seven hours for Financial Considerations both organs together, and most patients are hospitalized for two to Kidney Glossary three weeks. Pancreas-only transplantation is also considered in very selected cases where renal failure is not present but diabetes Features management is difficult, or where the patient is under threat of other What's New severe complications, such as blindness. Selectivity is based on a Kidney Research graft survival rate of at least 15 to 20 percent below that of and Development kidney/pancreas, though recent advances in this field have led to improved outcomes with pancreas-only transplants. Calendar of Events Kidney Newsletter The kidney/pancreas transplantation team includes transplant Downloads surgeons, endocrinologists and nephrologists as well as ancillary personnel. General Information Faculty and Staff Contact Information Web Links Site Map Search this site Submit USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  14. 14. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Rarely are pancreases transplanted independently of a simultaneous kidney transplant. Two instances that allow this procedure to be Laparoscopic Transplant considered are: Conventional Kidney Transplant q A Kidney-Pancreas Transplant Pancreas Transplant Information for Patients Transplant Patient Guide About the USC University Hospital Financial Considerations Kidney Glossary Features What's New Kidney Research and Development Calendar of Events person Kidney Newsletter has Downloads already received General Information a Faculty and Staff kidney Contact Information transplant Web Links from a Site Map living Search this site donor, but is still Submit in need of a pancreas transplant. q A prior pancreas transplant has failed. A successful pancreas transplant can benefit a diabetic person in at
  15. 15. least three ways: q Some types of diabetes-caused damage to the body may be controlled or partially healed. q Insulin injections are no longer needed and the person can enjoy a regular diet. q A person typically enjoys greater activity and independence. USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  16. 16. Home Page Areas of Expertise Bloodless Kidney Transplant Live Donor Laparoscopic Transplant Conventional Kidney Transplant q A Patient's Guide to Kidney Transplant Kidney-Pancreas Transplant Surgery Home Page Pancreas Transplant Information for Patients Transplant Patient Guide q A Guide to Medications - A comprehensive guide to About the USC preventative and protective drugs. University Hospital Financial Considerations q Kidney Transplant Team - Those who help make Kidney Glossary every transplant a success. Features What's New q The Organ Donation Process - Factors in Kidney Research donating and receiving a kidney. and Development Calendar of Events Kidney Newsletter Downloads General Information Faculty and Staff Contact Information Web Links Site Map Search this site Submit USC Kidney Transplant Program 1510 San Pablo Street, Suite 430, Los Angeles CA 90033-4612 Phone: (323) 442-5908 Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  17. 17. About The Kidney q How the Kidneys Work q Symptoms of Kidney Disease Before Surgery q Why a Transplant is Necessary q Pretransplant Evaluation q The Transplant Team q Preparing and Waiting for a Transplant During Surgery q Getting the Go-Ahead q At the Hospital q Preparing the Patient for Surgery q Kidney Transplant Surgery Procedure After Surgery q Waking Up in the Intensive Care Unit q Medical Management in the Acute Care Unit q Clinic and Follow-Up Visits This Web site was developed in q Lab Tests 1999 as a service provided by the q Additional Tests and Procedures USC Kidney Transplant Program. q Monitoring at Home This Web site provides selected q Resuming Normal Activities information available about kidney q Avoiding Infection transplantation which may become out of date over time. It is q Communicating with the Healthcare Team important that consumers see a healthcare professional for detailed Medications & Complications information about medical q Medication Guidelines conditions and treatment. This q Information About Specific Medications information is not intended to be a substitute for the advice of a q Postoperative Complications healthcare professional, or a
  18. 18. The Donation Process recommendation for any particular treatment plan. The USC Kidney q Factors in the Donation Process Transplant Program has made and q The Donor/Blood Type Compatibility will continue to make efforts to q The Waiting List and Other Concerns include accurate and up-to-date q Organ Procurement Organization (OPO) information on this Web site. q United Network of Organ Sharing (UNOS) If you have any questions, please contact us: Other Kidney Sources q Transplant and Medical Sources q Useful Web Links Glossary of Kidney Terms Site Map USC Kidney Transplant Program Translate this site using Alta Vista Phone: (323) 442-5908 Fax: (323) 442-5721 usckidney@surgery.hsc.usc.edu
  19. 19. HOW THE KIDNEYS WORK How the The kidneys are two Kidneys Work bean-shaped organs located toward the back of the body on either side of the spine near Symptoms of the waistline. They are about Kidney Disease the size of a fist and are protected by other organs and two of the lower ribs. Normal functioning kidneys serve the Glossary body in several very important ways. They: Site Map q Clean your blood and remove waste products Home q Balance water and salt to control fluid in the body q Control blood pressure q Help make red blood cells and strong bones q Control the amount of potassium, calcium, magnesium and phosphorus in the blood <Back Next> Symptoms of Kidney Disease If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  20. 20. SYMPTOMS OF KIDNEY DISEASE How the Kidneys Work Symptoms may include: Symptoms of q Fluid Kidney Disease retention q Shortness of breath Glossary q Change in mental status Site Map q Abnormal urine or Home blood test results q Headache q High blood pressure q Fatigue <Back Next> Why a Transplant is Necessary If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  21. 21. WHY A TRANSPLANT IS NECESSARY Why a Transplant A number of diseases can directly damage the kidney. Damage to the is Necessary kidney can seriously affect the removal of water and waste products, production of red blood cells, regulation of blood pressure and balance of electrolytes such as potassium, calcium and phosphorus. Pretransplant Evaluation If the damage is severe enough, transplantation may be necessary. A transplant provides a patient with a kidney that can keep up with the demands of a full, active life. Transplant Team Preparing for a Transplant <Back Next> Pretransplant Evaluation Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  22. 22. PRETRANSPLANT EVALUATION Why a Transplant Pretransplant tests, as well as giving a clear picture of the patient's is Necessary overall health status, help in identifying potential problems before they occur. They also help in determining whether transplantation is truly the best option. This increases the likelihood of success. Pretransplant Evaluation The following procedures help in evaluating a patient's health status: q Physical exam - Gives the doctor an overall picture of the Transplant Team patient's conditions. q Chest x-ray - Determines the health of the patient's lungs and Preparing for lower respiratory tract. a Transplant q Complete medical and surgical history - Determines what additional tests may need to be done. q Electrocardiogram (EKG or ECG) - Determines how well the patient's heart is working and may reveal heart damage that Glossary was previously unsuspected. q Ultrasound with Doppler examination - Determines the Site Map quality of the iliac vessels. q Blood tests - The patient's blood count, blood and tissue type, Home blood chemistries, and immune system function will all be checked. In addition, blood tests for certain infectious diseases will be performed. q Blood typing - Every person is a blood type A, B, AB or O. The donor's blood type does not have to be the same as the recipient's blood type, but it must be "compatible" (see crossmatch testing). q Pulmonary function test - The patient will be asked to breathe into a tube attached to a measuring device, which will reveal how well his lungs are working and determine his blood's capacity to carry oxygen. q Upper gastrointestinal (GI) series - This will show whether the patient's esophagus and stomach are disease free. q Lower GI series - Ensures that the patient is free of intestinal abnormalities. q Renal function studies - Urine may be collected from the patient for 24 hours in order to determine if the kidneys are working correctly. Blood tests such as serum creatinine are also performed to measure kidney function. q Tissue typing - This test is done on white blood cells. White blood cells have special "markers" that distinguish "tissue type", which are used to find a matching kidney. q Panel Reactive Antibody (PRA) - A way of measuring immune system activity within the body. PRA is higher when more antibodies are being made. It is easier to acquire a kidney if a recipient's immune system is calm or measures 0%. An immune system may be active from blood transfusion,
  23. 23. pregnancy, a previous transplant or a current infection. q Viral testing - Determines if the patient has been exposed to hepatitis, cytomegalovirus (CMV), Epstein-Barr (EBV), or acquired immune deficiency syndrome. q Mammogram - X-ray of a woman's breast that can detect signs of breast cancer. q Pap smear - Cells collected from a woman's cervix that are microscopically analyzed for signs of cancer. q Echocardiogram - Reveals any abnormalities in the heart. q Dental Evaluations - You need to have a dental check-up before you will be listed for transplant. Your dentist must tell us that your teeth and gums are healthy. You will also need to be checked by your dentist every year while you are waiting for your transplant. q Other tests - Any special tests or doctor visits that might be needed for the transplant workup. Histocompatibility Laboratory Tests Tissue Typing - This test is done on white blood cells. The white blood cells have special "markers" that tell your "tissue type". You inherit tissue type from your mother and father. This test is used to match a kidney and/or pancreas to you. Panel Reactive Antibody (PRA) - This test shows how active your immune system is. It is easier for you to get a kidney if your immune system is calm or measures 0%. Blood will be drawn at your dialysis center and sent to our laboratory. Your immune system may be active from blood transfusions, pregnancy, a previous transplant or a current infection. Crossmatch Testing - This test is done when a donor kidney is available. Your blood is mixed with the donor's blood. If there is no reaction (negative crossmatch) it means you are "compatible" with the donor. If there is a reaction (positive crossmatch), the kidney will not work for you because it is "incompatible". Other Tests - The transplant doctors will ask for any special tests they think you will need. For example, people with diabetes will need more tests for their heart. Your transplant coordinator or dialysis doctor can help you make arrangements for these tests. Clinical Laboratory Tests Blood Typing - There are four different blood types. They are A, B, AB and O. Every person has one of these blood types. The donor's blood type does not have to be the same. However, it must be "compatible" with your blood type for you to receive the kidney and/or pancreas.
  24. 24. Viral Testing - It is important for us to know if you have been exposed to hepatitis, cytomegalovirus (CMV), Epstein-Barr virus (EBV), or acquired immune deficiency syndrome (AIDS). We will test you for these at your clinic appointment. <Back Next> The Transplant Team If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  25. 25. ABSORPTION the degree and speed at which a drug enters the bloodstream from the small intestine Glossary <Back Site Map ACUTE TUBULAR NECROSIS (ATN) Home reversible kidney damage resulting in delayed kidney function. Among other factors, it may be caused by quality of donor organ, time of organ storage before transplantation, or medications to prevent rejection. <Back ALKALINE PHOSPHATASE an enzyme produced by liver (and other) cells; elevated blood levels of this substance may indicate abnormal function of the liver or other organs <Back ALLOGRAFT (allogenetic graft or homograft) a graft between two individuals who are of the same species (eg. human) but have genetic differences <Back ANEMIC low red blood cell count <Back ANESTHETIC medication that reduces pain by dulling sensation <Back ANTACID a drug that aids in protecting the digestive system and relieves heartburn and digestive discomfort <Back ANTIBODY a protein produced by the body to eliminate foreign substances, such as bacteria <Back ANTIGEN a foreign molecule or substance, such as a transplant, that triggers an immune response.
  26. 26. This response may be the production of antibodies, which, in turn, try to inactivate or destroy the antigen (transplanted organ) <Back ARTERIOGRAM (angiogram) an x-ray of the arteries taken with the aid of a dye <Back ATHEROSCLEROSIS a buildup of fats in the lining of the arteries that may interfere with the flow of blood <Back B Cell a specialized white blood cell responsible for the body's immunity. B cells play a central role in antibody production <Back BACTERIA small organisms (germs) that can cause disease <Back BIOAVAILABILITY a measure of how much of an administered drug is absorbed into the bloodstream, actually reaching the intended site of action in the body. For example, medicine is absorbed from the GI tract, travels through the bloodstream, and reaches the organ tissues, where it works to fight infection, prevent rejection, etc. <Back BIOPSY the removal and examination of tissue for diagnosis <Back BLADDER the part of the urinary tract that receives urine from the kidneys and stores it until urination <Back BLOOD UREA NITROGEN a byproduct of protein breakdown in the body <Back BRAIN DEATH when the brain has permanently stopped working, as determined by a neurological
  27. 27. surgeon, artificial support systems may maintain functions such as heartbeat and respiration for a few days <Back BUN BUN stands for blood urea nitrogen, a waste product normally excreted by the kidney. Your BUN value represents how well the kidneys function <Back CADAVERIC DONOR an individual who has recently died of causes that do not affect the function of an organ to be transplanted. Either the person or the person's family has generously offered organs and/or tissues for transplantation <Back CELLCEPT® an immunosuppressive drug used with other immunosuppressants to prevent the rejection of the transplanted organ. Also known by its chemical name, myophenolate mofetil <Back CHOLESTEROL a form of fat that performs necessary functions in the body but can also cause heart disease; cholesterol is found in animal foods such as meat, fish, poultry, eggs, and dairy products <Back COAGULATION blood clotting <Back CORTICOSTEROIDS a category of immunosuppressive medications that includes prednisone and prednislone <Back CREATININE a substance found in blood and urine; it results from normal body chemical reactions; high blood creatinine levels are a sign of depressed kidney function <Back CROSSMATCH a test in which donor and recipient blood samples are mixed together. A "positive" crossmatch shows the donor and recipient are incompatible. A "negative" crossmatch shows there is no reaction between the donor and the recipient. This means that the donor and recipient are compatible and the transplant may proceed.
  28. 28. <Back CYCLOSPORINE the immunosuppressive ingredient in Neoral® (cyclosporine capsules and oral solution for microemulsion) and Sandimmune® (cyclosporine), an earlier form of cyclosporine. Neoral® and Sandimmune are not bioequivalent and cannot be used interchangeably without physician supervision <Back CMV (CYTOMEGALOVIRUS) a virus infection that is very common in transplant recipients; it can affect the lungs and other organs as well; a member of the family of herpes viruses <Back DETOXIFY to change a harmful substance into a safer form <Back DIABETES a disease in which patients have high levels of sugar in their blood <Back DIALYSIS the process of cleansing and achieving chemical balance in the blood of patients whose kidneys have failed. Dialysis may refer to hemodialysis or peritoneal dialysis (PD) <Back DIASTOLIC the bottom of two blood pressure numbers, which measures blood pressure when the heart is at rest <Back EDEMA excess fluid in body tissues; swelling of the ankles, for example, is a sign of edema <Back ELECTROCARDIOGRAM a recording of the electrical activity of the heart <Back ELECTROLYTE generally refers to the dissolved form of a mineral such as sodium, potassium, magnesium, chlorine, etc.
  29. 29. <Back ENZYME a protein made in the body and capable of changing a substance from one form to another <Back FETUS a human embryo in the mother's uterus <Back GASTROENTEROLOGIST a physician who specializes in the care of the digestive tract <Back GINGIVAL HYPERTROPHY enlargement of the gums. It is a common side effect of cyclosporine therapy, but can be managed with good oral hygiene <Back GLUCOSE a type of sugar found in the blood <Back GRAFT an organ or tissue that is transplanted <Back GRAFT SURVIVAL when a transplanted tissue or organ is accepted by the body and functions properly. The potential for graft survival is increased when the recipient and donor are closely matched, and when immunosuppressive therapy is used <Back HELPER T CELL the specialized white blood cell that tells other parts of the immune system to combat infection or foreign material <Back HEMATOCRIT a measure of the red-blood-cell content of blood <Back
  30. 30. HEMODIALYSIS a method of dialysis in which blood is purified by circulating through an apparatus outside the body (sometimes called an "artificial kidney") <Back HERPES a family of viruses that infect humans; herpes simplex causes lip and genital sores; herpes zoster causes shingles <Back HIRSUTISM an excessive increase in hair growth - especially male-pattern hair growth in a female. Hirsutism is a common side effect of corticosteroids and can also occur with cyclosporine therapy, but is easily treated with depilatory creams or other methods of hair removal <Back HISTOCOMPATIBILITY the examination of human leukocyte antigens (HLA) in a patient, often referred to as "tissue typing" or "genetic matching". Tissue typing is routinely performed for all donors and recipients in kidney and pancreas transplantation to help match the donor with the most suitable recipients. This helps to decrease the likelihood of "rejecting" the transplanted organ. <Back HLA (human leukocyte antigens) system genetically determined series of antigens that are present on human white blood cells (leukocytes) and tissues <Back HYPERTENSION high blood pressure <Back IMMUNE RESPONSE any defensive reaction to foreign material by the immune system <Back IMMUNE SYSTEM the system that protects the body from invasion by foreign substances, such as bacteria and viruses, and from cancer cells <Back IMMUNITY a condition of being able to resist a particular infectious disease
  31. 31. <Back IMMUNOSUPPRESSIVE AGENTS medications given to prevent rejection of a transplanted organ <Back IMURAN® an immunosuppressive drug used with other immunosuppressive drugs to help prevent the rejection of a transplanted organ. Also known by its chemical name, azathioprine <Back INCOMPATIBLE no likeness or similarity between donor or recipient blood type or organs <Back IV, or INTRAVENOUS refers to giving medicines or fluids directly through a vein <Back IV CATHETER a small needle with a hollow tube inserted into a vein and used to give medicines or fluids <Back KIDNEY one of the two kidney-bean-shaped organs located on both sides of the spine, just above the waist. They rid the body of waste materials and maintain fluid balance through the production of urine <Back LIVING-RELATED DONOR (LRD) a blood relative who donates an organ <Back MATCH the compatibility between recipient and donor. In general, the more closely the donor and recipient "match", the greater the potential for a successful transplant <Back MICROEMULSION a suspension or mixture of tiny droplets of one liquid in a second liquid, such as the smooth mixture that is formed when Neoral® (cyclosporine capsules and oral solution for microemulsion) combines with fluids in the digestive system <Back
  32. 32. NEPHROLOGIST a physician who studies the kidney and treats kidney disease <Back NEUTROPHIL a type of white blood cell <Back NONCOMPLIANCE failure to follow the instructions of one's health care providers, such as not taking medicine as prescribed or not showing up for clinic visits <Back ORALLY by mouth <Back ORGAN PRESERVATION between organ procurement and transplant, organs require special methods of preservation to keep them viable. The length of time that organs and tissues can be kept outside the body varies, depending on the organ, the preservation fluid and the temperature. <Back ORGAN PROCUREMENT ORGANIZATION (OPO) OPO's serve as the integral link between the potential donor and recipient and are accountable for the retrieval, preservation and transportation of organs for transplantation. All OPOs are UNOS members. <Back ORGAN REJECTION an attempt by the immune system to reject or destroy what it recognizes to be a "foreign" presence (for example, a transplanted liver) <Back PANEL REACTIVE ANTIBODY (PRA) a way of measuring immune system activity within the body. PRA is higher when more antibodies are being made. <Back PCP Pneumocystis carinii pneumonia, a type of pneumonia seen primarily in patients whose immune systems are suppressed
  33. 33. <Back PERITONEAL DIALYSIS a method of purifying the blood by flushing the abdominal cavity with a dilute salt solution <Back PLATELET a small blood cell needed for normal blood clotting <Back POTASSIUM a mineral essential for body function <Back PREDNISONE a manufactured steroid hormone taken by most transplant recipients to help prevent rejections <Back PROPHYLACTIC MEDICATION medication that helps prevent disease <Back REJECTION an immune response against grafted tissue, which, if not successfully treated, results in failure of the graft to survive <Back RENAL refers to the kidney <Back RETRANSPLANTATION due to organ rejection or transplant failure, some patients need another transplant and return to the waiting list. Reducing the number of retransplants is critical when examining ways to maximize a limited supply of donor organs. <Back SANDIMMUNE® (cyclosporin) an earlier formulation of cyclosporine. An immunosuppressive drug used with other immunosuppressive drugs, that acts specifically to inhibit helper T cells, thereby helping prevent the rejection of a transplanted organ. Sandimmune and Neoral are not bioequivalent and cannot be used interchangeably without physician supervision
  34. 34. <Back SENSITIZED being immunized, or able to mount an immune response, against an antigen by previous exposure to that antigen <Back SHINGLES a herpes virus infection (herpes zoster) that usually affects a nerve, causing pain in one area of the body <Back SODIUM a component of table salt (sodium chloride); an electrolyte that is the main salt in blood <Back STATUS indicates the degree of medical urgency for patients awaiting heart or liver transplants <Back STRICTURE or STENOSIS a narrowing of passage in the body <Back SURVIVAL RATES survival rates indicate how many patients or grafts (transplanted organs) are alive/functioning at a set time posttransplant. Survival rates are often given at one, three and five years. Policy modifications are never made without examining their impact on transplant survival rates. Survival rates improve with technological and scientific advances. Developing policies that reflect and respond to these advances in transplantation will also improve survival rates. <Back SYSTOLIC the top of the two blood pressure numbers, which measures the maximum blood pressure reached as blood is pumped out of the heart chambers <Back THRUSH a fungus infection in the mouth <Back
  35. 35. TRIGLYCERIDES a form of fat that the body makes from sugar, alcohol, and excess calories <Back T CELLS a white blood cell responsible for the body's immunity. T cells can destroy cells infected by viruses, graft cells, and other altered cells <Back TISSUE TYPING a blood test (performed prior to transplantation) to evaluate the closeness of tissue match between donor's organ and recipient's HLA antigens. <Back ULTRASOUND a probe that uses high-frequency sound waves that pass into the body, are reflected back, to build an image of one's internal organs that is shown on a monitor <Back URETHRA a tube that drains urine from the bladder to the outside <Back URETERS tubes that drain urine from the kidneys to the bladder <Back URINARY TRACT INFECTION (UTI) an infection of one or more parts of the urinary tract <Back VIRUS a very small agent (germ) that causes infection <Back WAITING LIST after evaluation by the transplant physician, a patient is added to the national waiting list by the transplant center. Lists are specific to both geographic area and organ type: heart, lung, kidney, liver, pancreas, intestine, heart-lung, kidney-pancreas. Each time a donor organ becomes available, the UNOS computer generates a list of potential recipients based on factors that include genetic similarity, organ size, medical urgency and time on the waiting list. Through this process, a "new" list is generated each time an organ becomes available. <Back
  36. 36. WHITE BLOOD CELLS cells in the blood that fight infection; part of the immune system <Back If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  37. 37. Home Page Glossary About The Kidney q How the Kidneys Work Site Map q Symptoms of Kidney Disease Home Before Surgery q Why a Transplant is Necessary q Pretransplant Evaluation q The Transplant Team r Transplant Surgeon r Transplant Physician (Nephrologist) r Transplant Coordinator r Floor or Staff Nurse r Physical Therapist r Dietician r Psychologist / Psychiatrist r Social Worker r Pharmacist q Preparing and Waiting for a Transplant r The Telephone as a Lifeline r Make a List and Pack Ahead of Time r Getting to the Transplant Center r Dealing with Pretransplant Stress During Surgery q Getting the Go-Ahead q At the Hospital q Preparing the Patient for Surgery q The Kidney Transplant Surgery Procedure After Surgery q Waking Up in the Intensive Care Unit q Medical Management in the Acute Care Unit q Clinic and Follow-Up Visits q Lab Tests q Additional Tests and Procedures
  38. 38. q Monitoring at Home q Resuming Normal Activities r Skin and Hair Care r Sexual Activity r Smoking r Vacations and Travel r Dental Care r Pregnancy r Exercise r Diet and Nutrition r Alcoholic Beverages q Avoiding Infection q Communicating with the Healthcare Team Medications & Complications q Medication Guidelines q Information About Specific Medications r CELLCEPT® (mycophenolate mofetil) r SANDIMMUNE® (cyclosporine A, CyA, or CsA) r PROGRAF (tacrolimus) r DELTASONE® r IMURAN® (azathioprine) r ORTHOCLONE OKT®3 (MUROMONAB-CD3) r BACTRIM - PCP (pneumocystis Carnii Penumonia) r CYTOVENE® (ganciclovir) r ZENAPAX® r ZOVIRAX® (acyclovir) r Antifungal drugs r Drugs that protect the digestive system q Postoperative Complications r Infections r High blood pressure r Rejection r Diabetes The Donation Process q Factors in the Donation Process q The Donor/Blood Type Compatibility
  39. 39. q The Waiting List and Other Concerns q Organ Procurement Organization (OPO) q United Network of Organ Sharing (UNOS) Other Kidney Sources q Transplant and Medical Sources q Useful Web Links Glossary of Kidney Terms If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  40. 40. THE TRANSPLANT TEAM (Click on each for more information) Why a Transplant q Transplant Surgeon is Necessary q Transplant Physician (Nephrologist) Pretransplant q Transplant Coordinator Evaluation q Floor or Staff Nurse q Physical Therapist Transplant Team q Dietician Preparing for q Psychologist / Psychiatrist a Transplant q Social Worker q Pharmacist Each of the skilled health care professionals who make up the Glossary transplant team take a personal interest in answering a patient's questions and taking care of his medical needs. They will also help Site Map the patient keep his spirits up along the way. The patient is the most important member of the transplant team. To Home a certain extent, all the other team members will respond to his cues. The patient's physical, emotional, and practical needs will help them shape a personalized pretransplant and posttransplant treatment program. <Back Next> Preparing and Waiting for A Kidney Transplant If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  41. 41. THE TRANSPLANT TEAM Why a Transplant is Necessary Transplant Surgeon The transplant surgeon performs the actual Pretransplant transplantation procedure and monitors a patient's Evaluation medication before, during, and after surgery. He or she will assess the quality of the donor's kidney before Transplant Team surgery, and monitor the patient's general and kidney status following transplantation. Preparing for He or she will also check the patient's medication needs, a Transplant and periodically check the incision to make sure it is healing properly. Glossary <Back Return to: Transplant Team Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  42. 42. PREPARING AND WAITING FOR A KIDNEY TRANSPLANT Days and weeks may pass while the transplant team Why a Transplant waits for UNOS to locate the right kidney for a specific is Necessary patient. During this time, the patient should prepare as much as possible and take positive steps to deal with the Pretransplant stresses of waiting, always staying focused on reaching Evaluation the goal of transplant. q The Telephone as a Lifeline Transplant Team q Make a List and Pack Ahead of Time q Getting to the Transplant Center Preparing for q Dealing with Pretransplant Stress a Transplant <Back Next> During Surgery: Getting the Go-Ahead Glossary Site Map Home If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  43. 43. History of the National Organ Procurement and Transplantation Network Donation Factors In the early 1980s, the advent of the immunosuppressant drug cyclosporine made the transplantation of organs other than kidneys The Donor feasible. This development led individuals to appeal to the public through the media and their legislators for assistance in finding Waiting List suitable donor organs. The demand for these organs greatly exceeded the supply. OPO There was no centralized network to increase the utilization of scarce donated organs nor were there criteria governing how an individual obtained access to transplantation. To further complicate matters UNOS there was a growing concern that wealthy citizens of foreign countries were coming to the United States to take advantage of transplantation technology to the detriment of terminally ill U. S. citizens also in need of the same technology. Glossary These issues Site Map resulted in public demand for Home the implementation of a national system. Thus, the National Transplant Act of 1984 was passed by Congress. The act called for the creation of a national task force to study issues regarding transplantation and establishment of a new National Organ Procurement and Transplantation Network (OPTN). The OPTN includes all organ procurement organizations, transplant centers and tissue typing laboratories as well as patients, patient families, donor families, hospitals, voluntary health organizations and thousands of other dedicated individuals including physicians, other health care professionals, ethicists, clergy, social scientists, attorneys, health care management and government officials. The principal purpose of the OPTN is to ensure access to organs by critically ill patients and improve organ procurement and efficiency. Another key element of the OPTN is the development and administration of policy by the transplant community. The OPTN develops membership criteria standards based on training and experience of medical personnel. For example, an approved kidney transplant program should have a surgeon who has a year of training and a year of experience in kidney transplantation. In addition,
  44. 44. centers approved for liver or pancreas transplants should have a surgeon with training and experience in the transplantation of the organ being transplanted. The National Transplant Act was passed in October 1984. This act created a task force on organ transplantation that met over a period of 18 months and issued its report in April 1986. The Department of Health and Human Services (DHHS) awarded a one-year contract for the development and implementation of the national network to the United Network for Organ Sharing (UNOS) on September 30, 1986. UNOS immediately implemented parts of the network but did not complete full implementation until the end of the first year, as called for in the contract. The entire system went into effect October 1, 1987. The network has been fully operational for nearly 10 years. All clinical transplant centers, organ procurement organizations and tissue typing laboratories in the United States belong to and participate in UNOS. UNOS members have developed membership criteria based on the education, training and experience of medical personnel and monitor compliance with those standards to ensure high quality and consistent patient care. A national waiting list of all patients in the country waiting for solid organ transplantation is maintained on the UNOS computer system. UNOS operates a 24-hour-a-day organ placement center and computer system to ensure efficient and optimal matching of donors and recipients. Policies ensuring access to and allocation of organs are in place and are monitored through the use of a national computer system. To facilitate the development of policy and improve scientific methods, UNOS maintains a Scientific Registry, which contains scientific and demographic data on all organ donors and tracks all organ recipients throughout their lives. Members of the UNOS Board of Directors and its 15 permanent and 4 ad hoc committees include members of the public as well as patients. Included are experts from the fields of medicine, law, ethics, theology, social and behavioral sciences and health care financing. UNOS distributes the scientific and medical rationale for its policies for public comment and, where appropriate, holds public hearings. UNOS operates as the OPTN under contract with the U. S. Department of Health and Human Services and submits to department oversight, providing extensive information to the department for its review regarding OPTN policies United Network of Organ Sharing (UNOS) Every patient waiting for an organ transplant in the United States is registered in the UNOS computerized data network. All have equal access to donated organs. The 68 organ recovery organizations across the country are members of UNOS. When an organ procurement organization coordinator contacts UNOS, the UNOS technician inputs the organ donor's medical history, physical measurements, and blood type, and prints a computerized list of likely transplant recipients. The list is printed in order of matching priority, which includes medical criteria, length of time waiting, blood type, body weight, size of recipient diseased organ, and severity of illness. Kidney and pancreas recipients are also
  45. 45. matched by tissue (genetic) typing. If the first potential recipient does not match medically with the available organ, the OPO coordinator maintains the computer search in an assigned region or elsewhere in the nation for a potential recipient who most nearly matches the donor. Likewise, organ recovery organizations throughout the United States will notify each other when an organ becomes available for waiting recipients in their respective areas. Matching donor organs with recipients is critical. Transplant waiting times may vary from a few months to several years because of matching difficulties. <Back Next> Transplant and Medical Sources If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  46. 46. FACTORS IN THE DONATION PROCESS Donation Factors When an organ is donated from a person who has died, it is made available to an eligible patient on the waiting list. Before the transplant can take place, however, several The Donor things happen. Waiting List 1. The local Organ Procurement Organization (OPO) gathers information about the organ - size, condition, blood and tissue type - and sends this to the United OPO Network for Organ Sharing (UNOS). UNOS is a national organization that operates the patient waiting list, UNOS assuring equal and fair access for all patients to organs for transplantation. 2. A patient on the UNOS list who is most qualified for the organ - due to waiting time, blood and tissue match, and Glossary other factors - is selected and his or her center is notified. Site Map 3. Although a patient meets all the criteria and appears to be a good match for the organ, the organ still has to be accepted by the transplant center. The transplant team Home has a very short time to consider several factors before accepting that organ for the particular patient. If, in the physician's judgment, the organ offered presents undue risks to the patient, it may be refused. There are a number of reasons for refusing an organ, such as: q Patient condition - The patient may currently be too ill to undergo surgery. Or, the patient may be out of town or otherwise unavailable for surgery at that time. q Donor condition - The donor might have had high blood pressure, diabetes or some other illness that might have harmed the donated organ. q Organ condition - If an organ has been outside the donor's body for too long it might not work as well and may not help the patient. Or, the organ might have been damaged during recovery from the donor or during transit to the transplant center. Sometimes, final examination of the organ shows previously unseen risks, such as too much fatty tissue or badly formed blood vessels. q Donor/recipient compatibility - Critical "matching" tests, done just prior to surgery, sometimes reveal unknown incompatibilities that would result in failure of the transplant. q Transplant center factors - Geography may be a factor, as it may not be possible to get the organ to the center within a desirable amount of time.
  47. 47. There are some differences among transplant centers overall in terms of how often organs are accepted or refused. But recent studies have found that how often a center accepts or refuses transplant organs does not seem to affect such important factors as how long patients wait for transplant or how well those patients do either before or after transplant.* * From the United Network for Organ Sharing (UNOS') Summary of Key Findings 1113197. The UNOS 1997 Report on Center-Specific Organ Acceptance Rates. <Back Next> The Donor If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu
  48. 48. ORGAN PROCUREMENT ORGANIZATION (OPO) Donation Factors Each organ procurement organization (OPO) is one of 69 federally designated organ procurement centers across the United States. An OPO is responsible for matching The Donor organs from a patient who has died as a result of traumatic head injury with an individual awaiting a Waiting List life-saving organ - the gift of life. When a staff member at one of the hospitals affiliated OPO with an OPO calls to say that a potential organ donor has been identified, the donation process is set in motion. A procurement coordinator offers the next-of-kin the option UNOS of organ donation. If the family agrees, the coordinator calls the national computerized registry of the United Network of Organ Sharing (UNOS), in an effort to match medically and physically the organ donor with a waiting Glossary transplant recipient. The Role of the OPO Coordinator Site Map When a suitable recipient is found, the OPO coordinator Home notifies the surgeon who will transplant the organ. If the organ is indeed suitable, the transplant surgeon accepts the organ for transplantation at the recipient's transplant center. The OPO coordinator schedules the use of an operating room suite for the recovery of the donor organ(s) at the hospital where the donor remains. The coordinator also oversees the medical evaluation of each organ and assists in its surgical recovery. When the transplant surgeon accepts an organ offered by the coordinator, the transplant center's coordinator calls the waiting recipient, prepares the transplant center's operating suite, and coordinates the transportation of the organ procurement surgical team to the transplantation center. Individuals awaiting transplantation, as well as those who have received a transplant, are monitored medically by the transplant recipient coordinators at each transplantation center. <Back Next> UNOS: United Network of Organ Sharing If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721
  49. 49. E-mail: usckidney@surgery.hsc.usc.edu
  50. 50. THE DONOR Donation Factors Once doctors feel sure that someone is a good transplant candidate, the search for a new kidney will begin. The donor must be: The Donor q Free from disease, infection, or injury that affects the kidney Waiting List q Usually of the same or a compatible blood type (see table below) OPO BLOOD TYPE COMPATIBILITY CHART UNOS Can receive Generally can Blood Type kidney from: donate a kidney to: Glossary O O O, A, B, AB Site Map A A, O A, AB Home B B, O B, AB AB O, A, B, AB AB There are 3 different kinds of kidney donors: 1. Cadaveric Donor: A cadaver donor kidney (kidney/pancreas) is one that comes from a person who has just died. The family of this person has given permission for the kidneys, and possible other organs, to be donated for someone who needs a transplant. 2. Live Related Donor: A live related donor kidney comes from a blood relative, like a parent, brother, sister, or an adult child. Points to remember: q A kidney from a relative will be a better match. This means that there is less chance of rejection and you will not have to take as much (immunosuppressive) medicines. q There is no waiting time after the evaluation for a living related transplant unless the donor needs to have some medical problems taken care of. q You and the transplant team can plan when you will have the transplant surgery. q Fewer people need temporary dialysis after a living related transplant than after a cadaver
  51. 51. transplant. q The donor will need about 6-8 weeks to recover. 3. Live Unrelated Donor: A live unrelated donor kidney comes from someone who is not related to the person, like a spouse or a friend. Points to remember: q There is no waiting time after the evaluation for a living unrelated transplant unless the donor needs to have some medical problems taken care of. q You and the transplant team can plan when you will have the transplant surgery. q Less people need temporary dialysis after a living unrelated transplant than after a cadaver transplant. q The donor will need about two months to recover. q If you are thinking about a live donor transplant, there is one basic rule: The Donor Must Be Willing To Give You The Kidney Without Pressure From Anyone. Other information that might be helpful to know q The donor will not have to pay for the testing or the surgery. This is paid for through your health insurance. q The donor will need to have 6-8 weeks off from work to recover from the surgery. If the donor has been working before the surgery, it may be possible for them to receive state disability payments while they are recovering. q The donor will have many tests before the surgery. There will be laboratory tests, x-rays, a physical exam and a visit with the social worker. This testing is done to make sure that the donor is healthy. It helps to limit complications for both the donor and for you. q The transplant coordinator will arrange for testing of the potential donor. <Back Next> The Waiting List If you have any questions, please contact us: USC Kidney Transplant Program Phone: (323) 442-5908, Fax: (323) 442-5721 E-mail: usckidney@surgery.hsc.usc.edu

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