Transplantation is the preferred treatment option for many patients with kidney disease. Physician and dialysis centers refer their patients to the Transplant Center to be evaluated as a candidate for transplantation.

Patient referrals for kidney transplant at the University of Michigan require a comprehensive evaluation. When the referral is made to the Transplant Center, the evaluation process begins. The process includes patient education, medical records review, patient examination, and often additional medical testing. This portion of the process concludes when the case is reviewed by the multi-disciplinary transplant team and a decision about the patient's suitability for an organ is made.

The pre-transplant coordinators will be contacting the patient's referring physician's office for copies of their medical records. It is helpful for patients to verify that their records have been sent otherwise they need to hand carry them to their appointment. It is recommended that patients be current with their routine health care prior to their evaluation. Examples of routine health care may include dental exams and cleaning, and mammograms and pap smears as part of annual exams. Patients should bring copies of these results with them.

Patients will receive a packet of information in the mail. It is very important to review this information and complete the forms prior to arriving for the evaluation appointment. Patients will need to bring several things with them to their evaluation appointment, including complete insurance information, the completed transplant information forms, information on potential donors, and money for parking. It is helpful to gather this information well in advance of the appointment.

If a patient has a managed health insurance plan, the patient should call their insurance ahead of time to find out if they need a referral from their primary care physician for this evaluation. If one is needed, the patient should make sure it is received in time for the appointment.

If members of the patient's family are interested in donation (kidney), it is helpful to bring a list of their names, telephone numbers, birth dates and past medical histories.

When the patient comes for the pre-transplant, they should plan to be at the hospital for at least 5–6 hours. The patient will meet with several members of the transplant team including a transplant coordinator, nephrologists, surgeon, social worker, and a nurse educator. The evaluation appointment will include blood work, a chest x-ray, and an EKG. Each patient must attend the patient education class on transplantation. Patients scheduled in the morning attend this class at 11:45 a.m. following their clinic appointment. Patients scheduled for afternoon appointments attend this class at 11:45 a.m. prior to their afternoon clinic appointment.

The option of being transplanted with an organ from a living donor will be discussed at the evaluation appointment. Patients are encouraged to consider this option as they proceed through their evaluation.

The transplant coordinator gathers the test results needed to complete the pre-transplant evaluation. Once all the requested information is received the case will be presented to the multi-disciplinary transplant team. While most patients are candidates for transplantation, the team may require additional tests to help ensure the patient is healthy at the time of their operation. Local physicians and labs can often perform these tests. Occasionally it is necessary to require a patient to return to Ann Arbor to see University of Michigan physicians for additional evaluation. Once the multi-disciplinary transplant team determines that a patient is approved to be listed for a transplant, the coordinator begins the process of placing the patient on the wait list. The patient will receive notification of the transplant team's decision by mail. Each patient needs to identify at least one or two support persons to assist them through the transplant process.

Once the evaluation is complete and the patient has been cleared by the transplant team, the patient will be placed on the wait list. To remain active on the list, patients must keep up with the listing requirements. Listing requirements include submission of routine blood samples for antibody monitoring, scheduling visits to the University of Michigan transplant clinic, and follow up testing as requested. If these requirements are not met, the patient will be placed ‘on hold'; which will cause a delay in getting a transplant. It is in the patient's best interest to actively participate with the transplant team to ensure their medical results remain current while they are on the wait list. Other situations that may cause a patient to be placed on hold, include, but are not limited to, severe infections, stroke, heart attack, and operations. It is crucial for patients to keep the transplant team informed of any health changes.

Once a patient has been accepted as a transplant candidate and are listed for an organ they begin to accrue time on the national kidney transplant wait list. We routinely list patients on the wait list even when they are working towards identifying a living donor. This is done to provide the patient with equal opportunity to both avenues to transplantation. If a patient is not able to identify a living donor or if their living donor is not able to donate, the patient is being credited for wait time during their search for a living donor.

It is imperative that patients send in their monthly blood sample without fail. This sample is required in order to maintain active status on the transplant list. Patients who do not receive a blood draw kit should call the transplant office to obtain one. National rules require that patients who do not have a current blood sample will NOT be considered for any donor.

All acceptable kidneys transplant candidates are urged to identify potential living donors. Contact information is given to the patient, who can in turn provide that information to family and friends who may be interested in donating. Potential donors are asked to contact the living donor coordinator who will explain living donation. If the potential donor is interested in proceeding, they will be sent a tissue typing kit. They will take this kit to a local lab to have their blood drawn to be sent to the University of Michigan Histocompatibility Lab. Potential living donors are given thorough evaluation, similar to the process the recipient completes.

If there are multiple potential donors for a patient, the patient is asked to identify their primary donor. Donors are evaluated one at a time until an acceptable donor is found.

When an organ becomes available, a transplant coordinator will call the listed patient. It is important to remember that the transplant coordinator has only one hour to find a patient and accept the organ on their behalf. When a patient is called for a transplant, it is imperative the patient tell the transplant coordinator if they have been ill recently. An active infection or any other significant health problem may result in cancellation of the transplant surgery. After the organ has been accepted events move rapidly – from the time of the offer to the time the patient goes to the operating room. Patients receiving an organ from a deceased donor must be admitted and have their surgery as soon as possible.

The transplant operation generally lasts 2-4 hours. Following the operation the patient goes to the recovery room for four hours and then to their hospital room. Patients may be discharged between two and seven days after the procedures depending on how smoothly they recover from the operation. Most patients go home on the third or fourth day following the transplant surgery.

Before a patient leaves the hospital, the transplant team will instruct the patient about medications, diet, and everything else the patient needs to stay healthy.

Appointments for a patient's first follow up visits and lab tests are generally scheduled before the patient is discharged.

Immunosuppressive (anti-rejection) medications are given to prevent and treat rejections and must be taken on a regular basis for the rest of the patient's life or as long as the patient has their new organ. If a patient discontinues these medications, rejection will soon occur. Medications that may be utilized to prevent and treat rejection include Prednisone, Imuran, Neoral, Prograf, Cellcept, Rapamune, Myfortic, and Certican. All immunosuppressive medications can cause side effects. Every effort is made to reduce patient's side effects and most patients do well on their medications. The nurses and doctors will discuss these medications and their side effects in full when the patient is seen at the evaluation appointment.

The transplant community is joined under the nationwide umbrellas of the Organ Procurement and Transplant Network (OPTN) and the Scientific Registry for Transplant Recipients (SRTR). The transplant team is responsible to routinely report to the OPTN / SRTR lab and statistical information on all patients that are transplanted. Therefore, it is important that patients remain in contact with the transplant team. Please let the transplant team know if your contact information changes.