How do I prepare for my transplant evaluation?

What is the goal of the evaluation?

What will happen during the evaluation process?

How do I prepare for my transplant evaluation?
Your local doctor will let you know when it is time to meet with a doctor from the transplant team. He or she will ask you to call us to start the process. When you call us, we will send you a referral packet. At that time, you will need to do the following:

• Read the entire referral packet. If you need help reading or understanding the information, you may call the Transplant Center.
• Complete the Transplant Application in the referral packet. Return it to us in the envelope provided.
• Contact your health insurance provider to ask about your coverage. Explain that you will be having a kidney transplant evaluation at the University of Minnesota Medical Center. This is also a good time to discuss post-transplant costs for home care and medicines. (Your social worker will talk to you about this during your evaluation. A financial representative will also be available to talk with you if you have questions about your insurance coverage.)
• Complete the Release of Information form in your referral packet, and return it in the envelope provided. This will allow us to obtain your medical records. Once we receive your records, we will schedule your evaluation. If you are very sick, you may have to stay in the hospital during your evaluation.

What is the goal of the evaluation?
The goal of your evaluation is to decide if a kidney transplant is the best treatment for you. We will:

• Check for problems that might occur during or after your transplant
• Gather recent medical information for the surgery
• Review and adjust your diet and treatment so that you will be in the best possible health for your transplant
• Teach you more about kidney transplant surgery, after-care and what to expect while waiting for your transplant
• Allow you to meet the transplant team
• Discuss your kidney transplant options

What will happen during the evaluation process?
In most cases, an evaluation takes two to three days. It will consist of several doctor and clinic visits. You will also attend a two-hour pre-transplant class. We urge your family or close friends to come with you. You will receive a lot of information, so please take notes and write down questions. If you do not want to start or continue your evaluation, please let us know.

Doctor consultations
You will meet the transplant team doctors. Your transplant coordinator may be with you during some of these visits.

• The transplant nephrologist (kidney doctor) will review your records and complete an exam.
• The transplant surgeon will explain the operation, possible risks and donor options.

You may see other doctors as well, depending on your health history. Feel free to ask questions at any time.

Blood tests
You will have many blood tests, including:

• Blood type tests
• Tissue typing. This is used to find a matching donor kidney.
• Crossmatch testing. This test will show if your body will accept or reject a kidney from a given donor. A negative crossmatch is good – it means your body will likely accept the kidney. A positive crossmatch means that your blood reacted to the donor’s blood sample and your body will likely reject the kidney.
• An antibody level test. This tells us how active your immune system is.
• Standard tests to measure your overall health.
• PSA test for men over 50 (to check for prostate cancer).
• Pregnancy test for women of childbearing age.
• Tests for viruses such as hepatitis, Epstein-Barr, cytomegalovirus, varicella and HIV.

Nutrition consult
A dietitian will check your height and weight, then review your blood work. He or she will counsel you on how to eat a healthy diet and maintain a healthy weight. Please tell the dietitian if you would like to meet with him or her again.

Scans and X-rays
You may have a number of different scans and X-rays during your evaluation. These might include:

A chest X-ray

An ultrasound
This test uses sound waves to look at parts of your body. We may use it to look at your gallbladder, kidneys and blood vessels.
CT scan. You may have this test if you’ve had cancer or if earlier test results aren’t normal. You will lie on a table that moves into a scanner (a big machine with a hole in the middle). The scanner will take a series of pictures of the inside of your body. When we look at all the pictures together, we will have a 3-D (three-dimensional) view of your organs and blood vessels.

Heart consult
You may meet with a heart doctor (cardiologist). He or she will decide which heart tests you will need. These may include:

• EKG (elect4ocardiogram). Patches on your chest will record your heart’s rhythm.
• An echocardiogram. This is an ultrasound of your heart. Sound waves create an image of the heart on a video screen, showing us how your heart works.
• A stress test. We will give you medicine to increase your heart rate. Pads on your chest will record your heartbeat. This tells us about the blood supply to your heart.
• An angiogram. We will place a small, thin tube in your blood vessel. We use this test to check for blocked arteries in your heart.

Your doctor will give you more details about these tests. If you have ever had a stress test or angiogram, please have the results faxed to your transplant coordinator.

Breathing  tests
If you smoke, have smoked in the past, or have ever had lung problems (such as asthma), you will need special breathing tests (called pulmonary function tests). If you are a smoker, we recommend that you stop smoking.

Social services consult
You will meet with a social worker to discuss support services. He or she can help with changes that you and your family may need to make in the short-term. Your social worker can also answer questions about Medicare and discuss other financial concerns.
 
Financial consult
A financial case manager will discuss the costs of both the transplant and the medicines needed afterward. He or she will help you understand your insurance—what it will cover and what it won’t.

Psychologist
You may see our psychologist if you:

• Have a learning disability
• If you have had a kidney transplant before
• If you have ever had difficulty with following a medical care plan -- such as taking your medications on time

If you’ve ever had mental health treatment, we may request your records.

Drug screening
We may test you for drug use at any time. Heavy drug or alcohol use will require a formal evaluation for chemical dependency. You may need more treatment or a waiting period before we can proceed with the transplant.