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Typical Patient Journey: Kidney Transplant

Diagram illustrating the typical patient journey for a kidney transplant

Patient referred to the Transplantation Surgery program at Dartmouth-Hitchcock

This is usually done through a nephrologist (kidney specialist), or another doctor.

Initial patient evaluation with the transplant team

The team reviews in detail the patient's medical history and current physical condition. The patient will meet the transplant team, including the:

  • Transplant surgeon, who examines the patient and discusses the transplant procedure.
  • Transplant physician, who reviews the patient's medical history and performs a complete examination to identify conditions which may complicate a future transplant, such as heart disease.
  • Transplant coordinator, who tells the patient about the process of getting listed for a donated organ, and about the medications the patient will need after the transplant.
  • Dietitian, who discusses dietary restrictions before surgery with the patient, and suggests changes to the diet after successful surgery.
  • Social worker, who helps the patient use support resources before and after the transplant.
  • Financial advisor, who discusses insurance coverage with the patient, and alerts the patient to available financial resources.

Medical tests

In order to determine if the patient is a good candidate for a transplant, the transplant team will ask the patient's primary care physician (family doctor) to order several medical tests. These tests will identify any conditions that might cause problems during the transplant surgery, and help make sure that a transplant is the best treatment option.

Listing for transplant

Based on the evaluation and medical tests, the transplant team will decide if the patient is to be placed on the list for transplantation surgery.

Identifying a donor

There are two sources of donated kidneys: those from living donors and those from patients who have died (cadaveric donors). Kidneys from living donors provide the longest lifespan for both the patient and the kidney. Such kidneys can come from a living relative (brother, sister, parent, etc.), or from a living person not related by blood to the person who will receive the transplant (such as a spouse, adoptive parent, or a close friend).

Transplant waiting list

If it is not possible to arrange for a living donor, the patient is placed on the waiting list for a cadaveric donated kidney. The United Network for Organ Sharing is a nonprofit organization that coordinates US organ transplant activities. The organs are assigned based on many factors including waiting time, degree of matching, and location. DHMC has some of the shortest waiting times for deceased donor organs in New England.

While waiting for a cadaveric donated organ, a patient must:

  • Stay as fit as possible
  • Go to all routine health care visits, including dental checkups, flu shots, EKGs, stress testing, colorectal exams, mammograms and pap smears for women, and prostate exams for men.
  • Let the transplant center know immediately if the patient has a blood transfusion
  • Submit monthly blood samples. If the patient is on hemodialysis, the dialysis center can do this.
  • Let the transplant center know of any changes to the patient's address or phone number
  • Let the transplant center know of any changes in the patient's health status

Surgery

  • Living donor. The date and time of the operation is coordinated with the patient and donor. The patient comes to the hospital on the morning of the operation. The patient is prepared for surgery in the same day surgery center, and will begin taking immunosuppressant medications. The patient is then taken to the operating room for the transplant.
  • Cadaveric donor. Patients waiting for a cadaveric donor will be contacted once a kidney becomes available. The transplant coordinator will call, make sure the patient is in good health, and tell the patient what time to arrive at the hospital. Upon arrival, the patient will be examined and will begin taking immunosuppressant medications. The patient is then taken to the operating room for the transplant.

Hospital stay

For a kidney transplant, the patient will be in the hospital for a minimum of three days.

Clinic visits

At discharge from the hospital, the patient will receive an appointment card for a follow-up clinic visit. This is usually for the third day after discharge from the hospital. At this first visit, the transplant team will take some lab tests to track the patient's progress and find any potential problems.

The patient will have regular clinic visits for at least six months. After that time, the patient will return to his or her nephrologist or endocrinologist for regular care. The transplant team will continue to see the patient once a year at Dartmouth-Hitchcock.

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