Transplant Unit

Initial information

The recipient, the donor and their families should be given information at an early stage in the assessment process so that they can make an informed choice about assessment for live donor transplantation. This information is readily available from the transplant coordinator and other sources include health care staff at dialysis centres, kidney doctors (nephrologists), renal nurses, other patients and the media. The potential donor must be medically and psychologically fit and the donor and recipient must be shown to have compatible blood groups before any further work up is performed. The expected duration of the assessment process would be in the range 3 - 6 months and the following appointments would be arranged :

Appointment 1

• Consultant nephrologist clinic appointment at dialysis centre or pre-dialysis clinic
• Opportunity to visit transplant ward with transplant coordinator
• Patient information literature provided
• A blood sample is taken and sent together with urine samples for the following investigations:

• U&Es Urea & electrolytes - checks on the blood chemistry and kidney function.
• LFTs Liver function tests - checks for normal liver function.
• Cholesterol blood test to check for risk factors of disease affecting blood vessels.
• CRP & ESR (C-reactive protein & erythrocyte sedimentation rate) Non-specific tests to detect inflammation in the body.
• FBC Full blood count - checks to see if you are anaemic.
• Coagulation screen Blood test to check clotting activity.
• Fasting blood glucose to check the blood sugar level : abnormality may indicate diabetes.
• HbA1c Blood test to screen for diabetes : donors must not be diabetic.
• Microalbuminuria urine test to look for protein. Donors must not have abnormal levels of protein in the urine.
• Mid-stream urine specimen to check for urine infection
• Urinalysis A urine sample is tested for abnormality such as blood, protein or sugar content.
• 24 hr urine collection for protein and creatinine clearance measurements of kidney function. All urine passed over a whole day is sent to the laboratory for this test.
• ECG This routine test looks for any abnormality in the electrical activity of the heart.
• Blood pressure Donors with abnormally high blood pressure would not be acceptable.
• Chest X-ray Routine screening test for chest abnormalities.
• Virology screen These tests identify donors who may unknowingly be carriers of the following viruses which would be hazardous to the recipient following transplantation : Hepatitis B, Hepatitis C & HIV. Additional screening tests check for the following viruses which would not normally prevent the transplant from taking place : Cytomegalovirus (CMV) and Epstein-Barr Virus (EBV). Appropriate counselling should be offered before the donor gives consent to the HIV test.
• Tissue-typing tests to determine and compare the blood groups and tissue types of the potential donor and recipient, a lymphocytotoxic cross-match to help predict rejection problems, combined with a similar test to demonstrate the genetic relationship (this last test is omitted if the donor is not a blood relative of the recipient, but documentary evidence of the relationship would then be required for presentation to the Unrelated Living Transplant Regulatory Authority for their approval to proceed).

Appointment 2

• Proceed with work up as follows if above results acceptable.
• Renal ultrasound
• Nuclear medicine scans :
  GFR Glomerular filtration rate measurements allow comparison of kidney function to expected values
  MAG3 or DTPA scan To  measure the total percentage function of each kidney

Appointment 3

• At this stage the recipient and donor should be formally referred by the recipient's consultant nephrologist, documenting the above test results, to the transplant surgeons via the transplant coordinator.
• Consultant surgical review in clinic.
• Visit transplant ward with transplant coordinator.
• Independent professional donor interview should be offered (e.g. with counsellor).

Appointment 4

• Renal arteriogram Special X-ray procedure to show the anatomy of the donor's kidneys. This test allows the surgeon to avoid transplanting kidneys with multiple arteries. If a donor has more than one artery to both kidneys, it may not be possible to proceed with transplantation. The renal arteriogram is normally the last test before the decision to proceed to transplant.

• Surgical and radiological review of arteriogram
• Instruction to transplant coordinator to book operation
• Further tissue typing blood tests are carried out to evaluate any changes that may have occurred since these tests were first performed.

Live donor transplant