by Bobby Nibhanupudy, MD
In our last patient care issue we discussed the waiting list and how we decide who gets a particular donor organ. Now we’ll go through what happens when an organ is finally offered for you. For the sake of example, let’s say you’re a kidney transplant candidate, and an organ has been offered for you. The local organ bank will notify the transplant nephrologist or surgeon who then has approximately one (1) hour to locate you. If he or she cannot locate you within this time period, the kidney will then be offered for the next patient on the waiting list. This is why it’s important that you notify the transplant office whenever you are going out of town or have a change of address/phone number. At the University Transplant Program at Parkland we can actually help arrange for a transplant beeper for anyone on the waiting list. A beeper can be useful if you are often out of your home. The nephrologist is the one who usually contacts you. At that point you should come to the hospital as soon as possible. It may be that you are on dialysis at the time. If this happens, the nephrologist may just tell you to finish the dialysis session before coming in.
Once you have arrived at the hospital, your blood will be drawn for tests. The nephrologist and surgeon will also talk with you and examine you to make sure that you have not been recently ill or have had any worsening conditions such as heart disease since your last clinic visit. If you had not been in dialysis that day, they may decide that you need to have dialysis done before the transplant so that your body is as fit as possible for the operation. They will also describe to you once again the operation and what you will probably be experiencing for the next week or so in the hospital. If the blood tests and your physical exam are OK, then you are ready to go to the operating room…well, not quite yet. This is when there is a wait for a few hours. Why?
Well, while you have been getting a physical and maybe undergoing dialysis, the kidney has been packaged and sent in ice, with a special preservative solution in it. Some other tissues are also sent with the kidney so that a “crossmatch” is done. This is a process used to determine whether your body will immediately react with and reject the kidney on the operating table. This “hyperacute rejection” is the worst type because there is no way to reverse it. That is why the crossmatch is done before the operation. In this test, different components of your blood are mixed in various ways with the extra donor tissues to see if there is any reaction. If your blood cells react, then the crossmatch is “positive,” meaning that your body will not accept that particular donor’s kidney. The transplant is then canceled until you are called for another opportunity. If it is “negative,” then your body is not likely to cause the hyperacute rejection on the operating table. The crossmatching procedure takes about 4 to 6 hours to get done. This is why there is sometimes a wait even after your doctor says you are ready to go to the operating room.
What happens to the kidney if your transplant is canceled? Well, a donor kidney can be safely preserved for about 36 hours. So, there is usually time for it to be sent to the next person on the transplant waiting list, and the crossmatching process starts again. However, a kidney usually works best if it can be transplanted within 24 hours. This is why one or two “backup recipients” may be called into the hospital. These backup recipients are next in line on the waiting list and go through the same crossmatching process that you do at the same time. This allows us to find a crossmatch negative patient quickly if the kidney cannot be placed in you. Backup recipients are often called in if you have had a previous transplant or have had a positive crossmatch test in the past.
Once this test comes back negative and you have passed your physical, you will now be taken to the operating room for your transplant. In our next issue, we will discuss the operation and your hospital stay.
