Kidney disease can be categorized as either chronic, and does not require dialysis, or it can be end-stage which will need to be treated with either dialysis or transplant depending your medical status.
Kidney transplantation is widely recognized as an effective, and preferred, therapeutic option for the treatment of end-stage renal disease. Kidney transplant is a surgery done to replace a diseased kidney with a healthy kidney from a donor. At UCLA, we continue to care for you long after your transplant surgery is complete.
From the moment you walk through the door, through the procedure and for years to come, we take pride in our approach to care. We engage you in decision-making, in a personalized, culturally sensitive environment.
If you are interested in kidney transplant as a treatment option, there are different types of transplants to consider:
Living donor: A person who donates one of their kidneys to someone in need. Living donors may be blood relatives or individuals with emotional ties to the transplant candidate. Finding a living donor match dramatically shortens your waiting time, increases long-term transplant kidney and patient survival, and gives you the flexibility of scheduling your date of surgery. People who donate a kidney can live healthy lives with one healthy kidney. However, only 1 in 5 donors are healthy enough to donate a kidney, so if you do not have a potential living donor then if you are a candidate you will be placed on the waiting list for a deceased donor kidney.
Deceased donor: A kidney from an individual who has suffered brain or cardiac death and they generously donate their organs for transplant. The waiting time for a deceased donor kidney in the Los Angeles area is five to ten years and is based on your blood type, and sometimes longer, as the national waiting list continues to grow every year. A person getting a deceased donor transplant most often gets just one kidney, but in rare situations, he or she may get two kidneys from a deceased donor. The diseased kidneys are usually left in place and the transplanted kidney is placed in the lower belly on the front side of the body.
Multi-organ transplant: Our transplant surgeons work closely with other medical experts at UCLA, including the Urology Department, one of the nation's top programs. We have successfully transplanted multiple organs for complex patients, and our physicians and surgeons are skilled in transplanting all solid organs, including:
- Heart transplant
- Lung transplant
- Kidney transplant
- Liver transplant
- Pancreas transplant
- Small intestine transplant
Your transplant team will work with you to determine which option is right for you.
What to Expect: Support Before, During and After Transplant
We try to make evaluation and appointments as thorough and convenient as possible for you and your loved ones. Transplant Surgeons and Nephrologists participate in your transplant evaluation, as well as a Transplant Social worker, Dietician and Coordinator. These experts will work with you from diagnosis through discharge.
Our post-transplant protocols will help you return home as soon as possible after transplant. Our dedicated physicians and providers often continue to care for you for years to come. If you and your physician prefer, we will help your referring physician provide your follow-up care and get any needed answers. Our transplant recipients are part of the UCLA family, and we are available to care for them at any time.
Learn more about our patient education.
Your Transplant Process
The transplant process begins with a referral to the UCLA Kidney and Pancreas Program. You, your physician, your medical group or your dialysis unit social worker can make the referral. After we have gathered basic information, you will be scheduled for an Education Seminar and an evaluation appointment. You will be required to come with a primary and a secondary caregiver to the evaluation appointment that will be able to care for you after transplant and drive you to all of your post transplant appointments, so please make sure that your appointment also coordinates with their schedule. Your caregiver is extremely important to the success of your transplant which is why we require them to be with you during evaluation in order to prepare them for their role in your transplant.
The Education Seminar is intended to inform you about what to expect as you make your way through the transplant process here at UCLA Health. Even though you may have received information about transplant elsewhere, this appointment is important for you. This presentation by the transplant coordinator and social worker will help prepare you for kidney transplant and is a time for you to ask any questions you may have about kidney transplant and if this is the right treatment option for you.
Following the class you will be seen by our transplant team that is made up of the nephrologist, social worker, transplant coordinator and possibly the transplant surgeon. Additional blood tests may be drawn if you are found to be an acceptable transplant candidate to move forward. You will be given written information about what will happen next for you. The evaluation is a full day appointment so please plan accordingly.
What’s the next step after the evaluation appointment?
A care plan will be sent to you, your dialysis center (if you are on dialysis) and your referring doctor within two weeks after the evaluation outlining what additional test(s), if any, may be necessary to complete your evaluation. If you have been instructed that you need additional testing at the evaluation appointment, you must complete these tests in order for us to complete your evaluation. Once your tests have been completed and reviewed, your case will be presented to our Patient Selection Committee to decide if you are a candidate for kidney transplant or not. If you are approved for transplant we will then request financial clearance (authorization) from your insurance company. Once all of these steps have been completed, you will be placed on the Wait List.
If you are not a candidate, your coordinator will contact you to communicate the decision and if there are any additional steps you can take in order to become a candidate in the future. A letter will also be sent to you explaining the decision as well.
What happens once I am placed on the Wait List?
Once you are ACTIVE on the transplant list you should receive a letter in the mail notifying you that you are on the Wait List. You will be required to be seen in our UCLA Outpatient Clinic as instructed by your coordinator; usually every year once you are near the top of the Wait List. This may not happen for several years depending on your dialysis or list wait time and blood type. You will also be required to submit blood on a periodic basis for cross matching if an organ offer becomes available for you. It will be important for you to keep us updated on any insurance, dialysis, address, or phone number changes, as well as any changes in your medical status that may change your ability to be a candidate for transplant. Once your status becomes ACTIVE you could be called in for a transplant at any time. Be prepared!
If you are placed on HOLD status, you will not be eligible to receive a transplant but will continue to gain wait time. This can happen if you are temporarily too sick to transplant or have changes in your insurance, etc., and your coordinator will notify you and work with you on the reasons why this has happened. Once you are re-cleared for transplant your coordinator will re-activate you on the Wait List.
How do I make sure I stay active on the list?
Your coordinator will tell you how often you need to update medical tests (such as cardiac studies) or complete routine health maintenance tests. It is your responsibility to see that these tests are completed and results have been sent to your coordinator. These tests should be done with your primary physician unless instructed otherwise. If we do not have updated test results, you may be placed on a HOLD status until the tests are completed or you may be passed over for a kidney if we do not find current results. It may be helpful to follow up with your coordinator to assure the necessary records have been received.
How long will I be on the list?
There are currently over 100,000 people waiting for kidneys in the United States. The average wait time for a kidney could be five to ten years, depending on your blood type. Patients with blood type O experience the longest wait of ten years. It is important to discuss living donation with your family and friends in order to decrease your wait time.
Patients on the waiting list for a combined kidney/pancreas transplant will experience a shorter wait time.
What if I am not on dialysis yet?
You are eligible to be on the transplant list before you start dialysis, but you will not be eligible to gain wait time until your Glomerular Filtration Rate (GFR) is less than 20 so it is important to have your GFR tested regularly through your primary physician or nephrologists and get scheduled for a transplant evaluation once your GFR is below 20.
What should I do if I have a living donor?
Donors can be considered for evaluation after you have been seen for evaluation and deemed a transplant candidate to move forward in the evaluation process. Donors cannot be tested at your evaluation appointment, but are welcome to attend your appointment for general information. If you have an interested potential living donor, please have them complete this confidential, online health history questionnaire before coming in for an evaluation. If they are eligible to move forward they will be contacted by a member of our Living Kidney Donor team. If they are not a candidate they will be notified at the time they complete the questionnaire. Please make sure to communicate directly with your donor about their progress as we will not be able to share information about your potential donor with you as that is protected health information. Read about finding a living donor.
Who pays for donor evaluation and expenses?
Donor evaluation is performed at no cost to the donor and is paid for by the recipient's insurance. Recipients may have a benefit through their health insurance that would offset the cost of travel and lodging for potential living donors who need to travel to the transplant center. You are encouraged to speak with your insurance provider to find out if you have this donor benefit. In addition, there may be other financial resources available to assist your living donor with travel and lodging expenses. NLDAC is a federally-funded program providing financial assistance to those who want to donate an organ, priority is given to recipients and their donors who are not otherwise able to afford the travel and lodging expenses associated with living organ donation.
When will I get called in for a transplant?
If you do not have a living donor, there are two ways to receive kidney while on the Wait List:
- If a deceased donor kidney is “perfect match” to you, the kidney will be offered to you regardless of the amount of wait time you have. A perfect match kidney can come up at any time. This is why we ask you to be ready for a transplant at all times!
- If a perfect match kidney does not happen for you, you will wait up to seven to ten years for a deceased donor kidney to come to you based on a combination of wait time and match.
What happens when a kidney is available for me?
It is important that you keep your assigned transplant coordinator updated with current contact information so you can easily be located when a kidney becomes available. We have only one hour to locate you once a kidney is offered for you. If you can’t be located within an hour, you will be skipped over for that kidney, but will not lose your place on the Wait List. We often know who might get a kidney from a particular donor but do not know for sure until the test results are completed several hours later. Therefore, you might get a call placing you on “stand-by” and asking you to remain near your phone, ready to come to UCLA when called.
It takes several hours to prepare you and the surgical team. When contacted by the coordinator, you will be asked questions about your current health status and insurance. Once at the hospital, a physician will examine you, labs will be drawn, you will have a chest xray, and you will sign the consent to have the transplant surgery. Sometimes you will have dialysis before surgery.
What happens during surgery?
You will be taken to the operating room and put to sleep. A breathing tube will be inserted and a tube will be placed into your bladder to drain urine and make measuring your urine output easier. The transplant surgery takes about four hours, and after surgery you will go to a recovery room until you wake up. Once stable, you will be transferred to a room on the hospital floor where the kidney transplant recipients are cared for by a specially trained team. During your four to seven days in the hospital, you and your family or caregiver will be taught how to care for your kidney by our transplant coordinators, and a dietician will meet with you to discuss changes in your diet, while a social worker will meet with you and your family/caregiver to assure you all have adequate support at home after discharge. A transplant pharmacist will also meet with you to teach you and your family/caregiver about all of your new medications and their side effects. These teachings are extremely important to the sucess of your transplant and your caregiver will be required at all of the teachings.
What happens after I am discharged?
After you are discharged, you will be seen in the Transplant Clinic on the following schedule:
- Two to three times a week for the first month
- Once a week for the second month
- If you are stable after the first eight weeks, we will send you back to your primary physician or nephrologist to be followed regularly
- We will continue to follow you every 3 months for the first year and then once a year afterward
- Your primary doctor or nephrologist can refer you back to our team for any issues you may have in the future