Our first appointment of the morning was scheduled for 7:15 A.M in the Transplant Center. We met with Pre-Transplant RN, along with two other couples meeting with the transplant team that day, who provided us with a package of informational material and spoke briefly about what to expect throughout that day.
INFORMATION PACKAGE
The informational package provided included the following information:
- Talking About Transplantation - Living Donation: Information you need to know, United Network for Organ Sharing
- Talking About Transplantation - Questions & Answers for Transplant Candidates about Multiple Listing and Waiting Time Transfer, United Network for Organ Sharing
- Talking About Transplantation - Questions & Answers for Transplant Candidates about Kidney Allocation Policy, United Network for Organ Sharing
- Talking About Transplantation - What Every Patient Needs to Know, United Network for Organ Sharing
- Your Kidney Transplant: A Handbook for Transplant Recipients
- a list of members on the Renal Transplant Program, along with additional miscellaneous information about UNOS and the VA
SCHEDULE
The final piece of information was our schedule for the day, which looked like this:
- Meeting with the RN in the Transplant Center
- Lab - they drew 14 vials of blood from Ben for various tests
- Chest X-Ray
- EKG
- Renal Transplant Clinic Appts.
- Met with the Transplant Nephrology Fellow
- Met with the Transplant Team Resident
- Met with Transplant Nephrology MD
- Met with the Transplant Surgery MD
- Social Work Evaluation
- The "evaluation" isn't much of an evaluation at all, in psychological terms. It is more a brief, informal screen/assessment. It didn't last long at all, and it was our last appointment of the day.
Overall, this day was not so unlike the many, many other visits we have done at the San Antonio VA. Labs, Chest X-rays, and EKGs are done periodically anyway. It also isn't uncommon to meet with a different member of the nephrology team every time you have an appointment, so you get used to answering the same questions over and over again. Ultimately, the visit to the meet the transplant team turned out to be nothing out of the ordinary, so there was really no need for the pre-trip anxiety, LOL.
TRANSPLANT INFO
The transplant committee meets every Monday. As far as we have been told, the only thing left that they want are the biopsy results. These were included in Ben's post military medical file, which he provided to the nephrology team at the San Antonio VA. They were going to have it scanned into the system, but apparently it isn't showing up yet - no big surprise. Ben's SA VA transplant coordinator called today to ask about the test results, and he told her he had turned them in to the PA in nephrology but we have our own copy if needed.
From what we were told, there doesn't seem to be any reason Ben will not be added to the UNOS list when the committee meets. After that, it will probably take about another week before we hear from the the pre-transplant RN - she will call us to let us know that Ben has been placed on the list.
Ben's GFR continues to run between 15 and 19 percent. Oddly enough, the MDs from both transplant nephrology and transplant surgery spoke about possibly wanting to wait for up to one year before doing the transplant. It is an interesting line they must walk, choosing the best time to perform the transplant.
As I have mentioned in a previous post, it is best to do a transplant prior to a patient beginning dialysis. This has to do with the fact that the mortality rate increases for transplant recipients after beginning dialysis, so they do not want to wait too long. However, they do not want to do a transplant too soon either.
A living donor is preferable to a deceased donor, for the obvious reasons as well as the fact that a living donor kidney has a life of about 15-20 years, while a typical deceased donor kidney generally lives about 10 years. Being that Ben is a young kidney transplant patient, the wise thing to do is wait until we absolutely have to do the kidney transplant and pray that one of his living donors is a match.
LIVING DONORS
Once we hear from that Ben has been placed on the UNOS list, his living donors will have to contact his transplant coordinator to request being tested as a possible donor match. The transplant team is not allowed to contact a list of possible donors, as that would be considered solicitation.
The VA will begin testing possible donors one at a time. I'm unclear as to why they will only test one possible donor at a time.
Interestingly, most people would think a blood relative would be the best possible match. However, because Ben has a form of Chronic Kidney Disease that can return, a relative is not necessarily the best match. For some reason, the chance of the FSGS returning is higher when a blood relative match is used. Therefore, a non-relative match is actually preferable in cases such as Ben's.
QUALIFICATIONS FOR LIVING DONORS: Blood Type Compatibility Chart
Candidate's Blood Type Donor's Blood Type
O O
A A or O
B B or O
AB A, B, AB, or O
Being that Ben has an O blood type, it clearly limits his donor possibilities. If none of his living donors are a match, at least he will be on the UNOS list and accruing time.
Ben contacted his best-friend this-afternoon, to see if he knows what his blood type is; Ben's best-friend has already expressed interested in being tested as a possible donor. Can you believe that his best-friend is the exact same blood type?!?!?! GOD IS GREAT, ALL THE TIME!!!! This doesn't mean that his best-friend will be a match, but it is encouraging.
CONSIDERING BEING AN ORGAN DONOR?
Here are the organs that a living donor may give:
As I have mentioned in a previous post, it is best to do a transplant prior to a patient beginning dialysis. This has to do with the fact that the mortality rate increases for transplant recipients after beginning dialysis, so they do not want to wait too long. However, they do not want to do a transplant too soon either.
A living donor is preferable to a deceased donor, for the obvious reasons as well as the fact that a living donor kidney has a life of about 15-20 years, while a typical deceased donor kidney generally lives about 10 years. Being that Ben is a young kidney transplant patient, the wise thing to do is wait until we absolutely have to do the kidney transplant and pray that one of his living donors is a match.
LIVING DONORS
Once we hear from that Ben has been placed on the UNOS list, his living donors will have to contact his transplant coordinator to request being tested as a possible donor match. The transplant team is not allowed to contact a list of possible donors, as that would be considered solicitation.
The VA will begin testing possible donors one at a time. I'm unclear as to why they will only test one possible donor at a time.
Interestingly, most people would think a blood relative would be the best possible match. However, because Ben has a form of Chronic Kidney Disease that can return, a relative is not necessarily the best match. For some reason, the chance of the FSGS returning is higher when a blood relative match is used. Therefore, a non-relative match is actually preferable in cases such as Ben's.
QUALIFICATIONS FOR LIVING DONORS: Blood Type Compatibility Chart
Candidate's Blood Type Donor's Blood Type
O O
A A or O
B B or O
AB A, B, AB, or O
Being that Ben has an O blood type, it clearly limits his donor possibilities. If none of his living donors are a match, at least he will be on the UNOS list and accruing time.
Ben contacted his best-friend this-afternoon, to see if he knows what his blood type is; Ben's best-friend has already expressed interested in being tested as a possible donor. Can you believe that his best-friend is the exact same blood type?!?!?! GOD IS GREAT, ALL THE TIME!!!! This doesn't mean that his best-friend will be a match, but it is encouraging.
CONSIDERING BEING AN ORGAN DONOR?
Here are the organs that a living donor may give:
- single kidney
- segment of the liver
- lobe of a lung
- portion of the pancreas
- portion of the intestine
In order to qualify to become a living donor, you must be physically fit; in good general health; and free from high blood pressure, diabetes, cancer, and kidney, heart, liver and lung disease. You also cannot have HIV or hepatitis. Candidates are generally between the ages of 18 and 60. These donations may be directed (for a specific person) or non-directed or altruistic donations, whereby you donate to an anonymous person on the wait list. If both parties agree, the donors may eventually meet the transplant candidate.
The first test is, obviously, a blood test, for the following purposes: blood type; tissue typing; crossmatching ( another type of blood test done prior to transplant to see if the candidate will react to the donor organ); and an antibody screen. Additional tests include: a 24-hour urine test, to check kidney function; chest X-ray and EKG; radiologic testing, to allow doctors to view the organ you want to donate; psychosocial and/or psychological evalutation; gynecological examination; and a cancer screening.
If the transplant candidate is covered by private health insurance, or if they are going through the VA, the donor's medical expenses are generally covered.
In terms of a kidney donation, surgeons now have the option to use a laparoscopic procedure in which the donor will have three small incisions in the abdomen, affording a potentially shorter recovery time. Most kidney donors remain in the hospital for 3 - 7 days post-surgery and return to normal activities after 4-6 weeks of recovery.
On a completely unrelated side-note, it is 104 outside evening. Although our air-conditioner seems to be providing the 20 degree cooling the apartment managers claim it should provide, that still means it is 83 degrees in the apartment right now. UGH!!!! Please continue to pray for some rain down here in Texas. I cannot wait for some cooler autumn weather.
The first test is, obviously, a blood test, for the following purposes: blood type; tissue typing; crossmatching ( another type of blood test done prior to transplant to see if the candidate will react to the donor organ); and an antibody screen. Additional tests include: a 24-hour urine test, to check kidney function; chest X-ray and EKG; radiologic testing, to allow doctors to view the organ you want to donate; psychosocial and/or psychological evalutation; gynecological examination; and a cancer screening.
If the transplant candidate is covered by private health insurance, or if they are going through the VA, the donor's medical expenses are generally covered.
In terms of a kidney donation, surgeons now have the option to use a laparoscopic procedure in which the donor will have three small incisions in the abdomen, affording a potentially shorter recovery time. Most kidney donors remain in the hospital for 3 - 7 days post-surgery and return to normal activities after 4-6 weeks of recovery.
On a completely unrelated side-note, it is 104 outside evening. Although our air-conditioner seems to be providing the 20 degree cooling the apartment managers claim it should provide, that still means it is 83 degrees in the apartment right now. UGH!!!! Please continue to pray for some rain down here in Texas. I cannot wait for some cooler autumn weather.
