The usual kidney transplant recipient workup is an extension of good kidney care as patients move from diagnosis of new kidney disease to chronic kidney disease (CKD) to end stage kidney disease (ESRD) requiring renal replacement therapy (RRT, rx dialysis or transplant). In many modern health care centers, pill CKD clinics allow the patient to be closely monitored and document progression of disease until it is clear that dialysis or transplantation will be required. When this becomes the case, you and your Nephrologist will discuss this need and if you wish, you will be referred to the Transplant Center for assessment of candidacy.
The transplant recipient workup is designed to screen patients to determine whether they have any medical contraindications to receiving a kidney transplant as well as determine if they are able to tolerate a major operation in order to facilitate this.
This is also the time at which you would declare if you have a living donor who has stepped forward in interest of donating you a kidney, or if you have potential family, friends, acquaintances who might be donors for you.
The first set of testing includes updates of routine bloodwork and urine testing, then systemic assessment of heart function (EKG, ECHO, MIBI, Stress testing), lung function (PFT), Gyne (Pap, Mammogram), Urologic (PSA, prostate examination), and cancer screening (colonoscopy, chest X-rays, blood tumor markers, fecal occult blood testing, etc). You will then have scheduled interviews with various members of the Transplant Team including: Recipient Coordinator, Social Work / Psychology, Nephrologist and Transplant Surgeon. Based on these interviews, additional specific testing may be requested.
Once all the testing is complete, which can take upwards of 3 months or longer, your file will be reviewed at weekly Transplant Team Rounds and acceptability for transplantation will be determined by the committee. Assuming that you are approved as a potential kidney transplant, you will then be notified, and your file will be placed in the blood-group specific waitlist for transplant. If you are not yet on dialysis, then you will not commence on the waitlist until you have started, and if you have been already been on dialysis for some time, you will get credit for the time you have spent on dialysis already. You will continue to see you own Nephrologist going forward for routine kidney care and dialysis prescription, and periodically come back to the Transplant Center for status updates and interviews every so often, more frequently as you get higher on the waitlist (1-3 years).
Because the waitlist can be quite long, and because you may have health issues that continue to develop in the intervening periods between reassessments, you and your Nephrologist should continue to update the Transplant Center as to your health status in light of any significant new health developments such as surgeries, heart conditions, lung conditions, stroke, peripheral vascular disease, etc. If you do develop a significant health issue in the meantime, your file will be put on “hold” until the issue is resolved and then you will be reassessed by the Transplant Team to go back on the waitlist again. If you are fit for relisting, you will get credit for any time you have “lost” on the waitlist due to your illness; i.e: you will not lose any time from being on hold.