Transplant 101

Image courtesy of pbfluids.com

Back when I was still in hospital, my nephrologist spoke to us about kidney transplant. He said, that in my present age(50) and condition, he is recommending that I undergo work up for a transplant. He spent an hour by the bedside patiently explaining several aspects of this kidney replacement therapy option. And there were many. There are two possibilities for a transplant; from a live donor, preferably a relation of the recipient, who voluntarily comes forward to donate one of his/her kidneys, or when the prospective recipient’s name is enrolled under the cadaver program and shall wait to be called as he/she moves up on the list and when a match for him/her is found.

A requirement for a live donor, aside being between 18 to 60 years old, is that there should be some emotional attachment/relationship with the recipient. Blood relation is preferred as tissue matching could be easily found among close kin. If not related, a friend, spouse, anybody with some close association with the recipient is allowed. Even an employer-employee relationship is acceptable. It is not true that one can ‘shop’ around for a matching kidney for the right price from a line up offered and paraded by physicians. If ever that practice existed before, well it doesn’t anymore. At least not legally. We have heard stories about individuals who sell their organs to the affluent buyer because they needed the money. I do not know if they were ever true and if it continues to exist. As long as there is a donor with a confirmed emotional attachment with the recipient, and both pass all medical clearances and have the capacity to pay, then a transplant can be scheduled.

On the other hand, when you are listed with the cadaver program, your hospital keeps your updated record in their database and your name moves up the list as others before you get their transplants. Donors are individuals who are declared brain dead but whose basal systems are still in function through life support. These may be victims of accidents, aneurysm or stroke. They can be card-carrying donors or one whose family decides to take that route. Of course this option is more expensive than when one has a live donor. There is an extra fee that goes to the donor’s family as well as for funeral expenses. Even the cost of transferring the donor from somewhere else to your hospital is charged to you. Of course your transplant team will make sure you get a proper match. Even if you were on the top or number two in the list, if the donor is not an ideal match, then someone down the line can be the recipient. You have to regularly submit lab results so the information is updated as you can be summoned anytime. According to my nephrologist the wait time is about six months to one year.

To get to be eligible for transplant via a live donor or through the cadaver list, there are very stringent requirements. You have to get clearances from about every medical specialty there is; Cardiology, Pulmonology, Gastroenterology, Neurology, even Psychiatry and Dental. And the process can be a slow one especially if you have to juggle all these around work. First, you are required to attend a half day orientation to make sure both the donor and recipient is educated on the particulars of transplant. It’s a lively discussion with a panel of doctors and allied medical personnel and even a is priest present. A very helpful open forum where the attendees could ask anything related to the disease and the transplant program.

Then you proceed to get your clearances from one physician, one test to the next. I had a chest X-ray and a 2D Echocardiogram last week. I’m scheduled to have the Rest and Exercise Myocardial Profusion Imaging test this coming week. Also, since I had blood transfusion just almost a month ago, I have to wait a little bit more before they could draw tissue for typing and crossmatching purposes. This is to make sure my system has stabilized with the four units of blood i received through transfusion and not get a false sample. Who knows, I might even have a live donor already. But we both have to work up for it, as the donor has a list of clearances to undergo too. I like it that the program is taking no shortcuts. This ensures ideal donor-recipient  matching and higher survival rates. 

Next, more on transplants.