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Frequently Asked Questions

Please do not hesitate to ask your questions—however trivial they may seem to you. Every step of the way, your Transplant Coordinator will be available by telephone to answer any questions—and there is no such thing as a "silly" or "dumb" question. Please feel free to ask any questions, at any time, for any reason. We are here to help you.

Your Transplant Coordinator is available if you have any questions or concerns, and you may, of course, contact any member of the Kidney Transplant Team at any time with your questions.

The staff at the Kidney Transplant Center will answer all calls between 9 a.m. and 4 p.m., Monday through Friday, except holidays. The Transplant Coordinators will return these calls at their earliest convenience, usually the same day that you call. The Transplant Office number is 610-619-8420. Leave your name and telephone number where you can be reached. Try to be as specific as possible when you leave your message. Your call will be returned during the next business day. If you need to speak to a Transplant Coordinator during weekends, holidays or after hours, ask the answering service to page the Coordinator, who will return your call. If you have call block, please remember to remove it when expecting a call from our staff.

In an emergency: Call 911 immediately.

In the event of a life-threatening emergency, such as chest pain, coma, breathing problems, or bleeding, call 911 and they will take you to the nearest hospital emergency room. You and your family should always ask the physicians in the emergency department to call the Crozer Health Kidney Transplant Center, but DO NOT try to drive to Crozer Health in an emergency. Call 911.

Kidney Transplant at Crozer Health

From a practical point of view, the closer you live or work to the transplant center, the better; but it’s as important to choose a transplant center where you feel comfortable and confident in the transplant team’s abilities. A matching kidney could be found at any time and the travel time to the transplant center is important when you are waiting for an organ. Most transplants typically take place within 24 hours of an organ becoming available. The Kidney Transplant Center at Crozer Health is located off I-95 just South of Philadelphia, very convenient for people who live in Eastern Pennsylvania, New Jersey, Delaware and Maryland.
There are many factors to consider when choosing the right transplant center for your transplant surgery, including:
- Preference of Hospital and Location
- Lifetime Surgical Experience of the Transplant Team
- Pre- and Post-Transplant Services and Support
- Transplant Center Hospitality and Housing Availability
- Your Insurance Company’s Preferred Transplant Centers
While our Kidney Transplant Center itself may be new, our Kidney Transplant team is one of the most experienced and highly skilled in the Delaware Valley, having cared for more than 1,000 kidney transplant patients since 1995 with outstanding patient and graft survival rates at one year and beyond.
A Crozer Health Transplant Coordinator will be with you throughout your entire transplant process, responsible for coordinating your treatment and follow-up care. Our Transplant Coordinators are also responsible for setting up your transplant evaluation, keeping you informed of your progress toward transplantation, for your care in the Crozer Health Kidney Transplant Center, for providing additional education and support while you are in the hospital as well as coordinating your yearly follow-up care.
A Patient Navigator service is available for every Crozer Health Kidney Transplant patient. The purpose of the Patient Navigator is to assist Crozer Health patients and their families with getting answers to their questions, advice on available support resources, assistance with special needs and facilitating problem solving—basically, navigating the patient experience at Crozer Health.
Crozer Health lies in the heart of a multicultural region. Conversational and medical interpretation services are available for our non-English speaking patients and their families. If you would prefer that your healthcare be provided in a language other than English, please ask your Transplant Coordinator to arrange for an interpreter for you. For questions about medical interpretation, call the Kidney Transplant Center office at 610-619-8420 weekdays between 8:30 a.m. and 5 p.m.

We also offer services for hearing or sensory impaired patients. Available services include:
- Credentialed sign language interpreters
- Over-video sign language interpreters
- TDD teletypewriters
- Special nurse call buttons
- Closed caption televisions

The Transplant Team

The Transplant Team is a group of healthcare professionals who are here to assist you before, during and after your transplant. However, the most important decision maker is YOU. These are the people who will be working closely with you to make your transplant as successful as possible. Each team member is an expert in a different area of transplantation:

Transplant Surgeons

One of your first appointments will be with one of our Transplant Surgeons, one of the doctors who will perform your kidney transplant surgery.

Transplant Nephrologist

A Transplant Nephrologist is a kidney doctor who specializes in transplant and is the doctor at the Crozer Health Kidney Transplant Center who manages your medical care, tests, and medications. This physician does not perform the surgery but focuses on your care before and after the operation. During your evaluation, you will meet with one of our transplant Nephrologists who will review your medical history and examine you in order to help determine if you are a candidate for transplantation.

Transplant Urologists

Our Urologists specialize in the unique urological needs and care of kidney transplant patients. Like our Transplant Neprhologists, these physicians do not perform the transplant surgery; rather, they focus on your care before and after the operation.

Transplant Nurses, Nurse Practitioners and Physician Assistants

These healthcare professionals work closely with you while you are in the hospital and with the Nephrologists, Urologists and Surgeons to evaluate your health both before and after your transplant. After your transplant, our nursing staff will oversee your care throughout your in-hospital recovery.

Transplant Coordinators

Our Transplant Coordinators are with you throughout the entire transplant process, responsible for coordinating your treatment and follow-up care. Our Transplant Coordinators are also responsible for setting up your transplant evaluation, keeping you informed of your progress toward transplantation, and providing additional education and support while you are in the hospital as well as coordinating your yearly follow-up care.

Clinical Immunologist

The Clinical Immunologist has special training in the immune system and will be part of the team that evaluates and monitors you before, during and after transplantation.

Dietitians

Good nutrition has been proven to significantly enhance healing and outcome following surgery. Our Dietitians are available throughout the transplant process to provide nutritional advice to help you remain as healthy as possible. What you eat and drink is very important to your overall health and healing. You may meet with them during clinic visits or when in the hospital.

Transplant Social Workers

You will meet one of our Social Workers during the evaluation process. They can assist you with any non-medical issues before and after your transplant and help you and your family understand and cope with the variety of stresses and other problems you may experience during your illness. They can also give you important information regarding Medicaid, Medicare and other insurance questions.

Transplant Financial Coordinators

The Financial Coordinator has detailed knowledge about financial matters, insurance and hospital billing. This coordinator will work with you and the other team members to coordinate the financial aspects of your care before, during, and after your transplant and help you work out the best way to pay for your transplant. Our Financial Coordinators will also help you obtain preauthorization for your evaluation exams, kidney transplant surgery, and follow-up care. They can also answer any questions you may have regarding your healthcare coverage.

Transplant Pharmacists

The Transplant Pharmacists specialize in providing you with education about the medications that you will need after your transplant. They are available to answer questions about your medications. Our on-site pharmacy carries the transplant medications that you will need, and if you live at a distance from Crozer Health, they can coordinate your medication needs with a pharmacy close to home.

Your Primary Care Physician (PCP) or Primary Nephrologist

In most cases, you will continue care under your personal doctors before and after your kidney transplant. Your primary doctors are a very important part of your healthcare team and should be your point of care for any non-transplant related health issues, such as arthritis, back problems, diabetes, and the common cold. After your transplant medications have been adjusted, your primary doctor will manage your non-transplant related healthcare. Your Primary Care Physician or Primary Nephrologist can also coordinate medical care with your transplant team, especially if you have to travel a long distance to have your transplant. And of course, the Crozer Health Kidney Transplant Team will be available if you or your doctors have any questions regarding your health.

The Psychiatrist will meet with you and your family to examine and assess neuro-psychological function and to provide emotional support during this challenging time.

Family and Friends

Transplantation is not something you want to tackle alone. In fact, it’s very unlikely that anyone can go through this process alone. Every patient will come to a point where he or she needs help and encouragement to make the journey. The Kidney Transplant Team recognizes that a strong support team produces the best outcome. We, therefore, want to make sure that you have a support system in place. This means that you have family or friends that are willing and available to drive you to and from your appointments and take care of you before and after your transplant. It’s a big job, but it’s just so important.

You

You are the most important part of this process. The success of your transplant is directly related to your compliance with the medications, clinic visits, and adherence to the rules set up by your colleagues on the Kidney Transplant Team. You must maintain a nutritious diet and keep a routine exercise program tailored to your physical abilities. Receiving a kidney transplant is a lifetime commitment.

The Evaluation

The evaluation to determine your candidacy involves not only understanding your physical health but also understanding the psychological issues that may impact your ability to successfully handle a transplant. It involves considering your social situation and the ability of your friends and family to support you emotionally and logistically should you have any post-operative problems.

Why is that? It’s because Kidney Transplant Centers like Crozer Health have a responsibility to assure that transplanted organs, which are so precious and difficult to come by, are placed with recipients who will benefit the most from receiving them. Crozer Health takes this responsibility very seriously.
The evaluation process begins with a recommendation by your primary care physician and/or nephrologists for an evaluation by the Crozer Health Kidney Transplant Team in order to determine if you are a good candidate for transplantation. With that recommendation, a letter requesting rather extensive preliminary information will be sent to you and your doctor to in order to understand your current medical condition. It is important to understand that the Transplant Team cannot evaluate you until we receive this information.
The following tests are given to all transplant candidates. Sometimes, there are additional tests specific to your personal health and care situation or based on any results of the testing that needs further investigation. Some insurance policies require that you obtain referrals for each one of these tests. Be sure to obtain all the necessary paperwork before you come in for these exams. Ask your Financial Coordinator if you have any questions about the paperwork.

Learn More
Your evaluation appointment will be four to six hours long. The evaluation process focuses on a variety of tests and analyses to determine if you are a good candidate for transplantation and if transplantation is truly the best and safest option for you. At your evaluation appointment, you will also learn more about kidney transplantation as a treatment option as well as the option of living donation.
At Crozer Health, all patients are considered potential candidates unless proven otherwise. Potential candidates should be well informed and demonstrate adequate health behavior and a willingness to adhere to guidelines from the Kidney Transplant Team as well as from other healthcare professionals.

Absolute contraindications to kidney transplant include, but are not limited to, the following:
- Any widespread or untreated cancer
- Significant mental impairment
- Medical unsuitability
The following are relative contraindications to kidney transplantation.
- Treated Malignancy: The cancer-free interval required will vary depending on the stage and type of cancer. Clearance by a board-certified oncologist is required in these cases.
- Substance Abuse: Evaluated on an individual, case-by-case basis.
- Chronic Liver Disease: Candidates with chronic hepatitis B or C or persistently abnormal liver function testing must have hepatology clearance prior to consideration.
- Heart Disease: All patients over the age of 50 with a history of diabetes must have a cardiac catheterization. Any patient with a history of a positive stress test or history of congestive heart failure must have cardiology clearance prior to consideration.
- Urology: For all patients with a structural genitourinary abnormality or recurrent urinary tract infection, urologic clearance is required prior to consideration.
- Mental health: Candidates who are psychiatrically unstable or adherence impaired as well as those with un resolvable psychosocial problems or the absence of a reliable or consistent social support system may be excluded from kidney transplantation.
- Aortoiliac Disease: Patients with abnormal femoral pulses or disabling claudication, rest pain or gangrene will require evaluation prior to consideration.
- HIV: Candidates who are HIV-positive are considered for transplantation on an individual basis.
- Age: Age is not an excluder for kidney transplantation. Candidates are evaluated on an individual basis.
Failure of any portion of the kidney evaluation could result in our inability to provide you with kidney transplant surgery. Every candidate is evaluated on an individual basis and all necessary actions will be taken to correct any abnormalities or issues that may arise.
Several factors are considered when determining who will receive the available kidneys, including:

Blood Type: Every person is a blood type A, B, AB, or O. For deceased donors, the blood type must be the same. For living donors, the blood types must be compatible.

Tissue Type: Each of us has several genetic markers located on the surface of most of our white blood cells. One particular group of genetic markers is called HLA or Human Leukocyte Antigens (leukocyte refers to white cell and antigen refers to genetic marker). Tissue Typing is the name given to the test that identifies an individual's HLA. This information is critical before a patient receives a donor organ.

Certain antigens are used in choosing potential recipients and donated kidneys. In order to carry out tissue typing, a blood sample is drawn and the genetic markers on the blood cells are identified. Each marker has a letter and number in its name. For example, two common antigens are known as HLA-A1 and HLA-B8. Over 100 of these antigens have been identified. Some of the antigens are more common than others. A 6-antigen match is the best possible match for kidney transplants.

Cross Match: Your immune system may produce antibodies that act specifically against something in the donor's tissues. To see whether this is the case, a small sample of your blood will be mixed with a small sample of the donor's blood in a tube. If no reaction (negative crossmatch) occurs, you should be able to accept the kidney

If the available kidney matches up with you, and it is deemed healthy enough for transplant, we will begin your procedure as soon as possible.
It can sometimes take several weeks for the results of your tests to come back and for your evaluation to be complete. When your pre-transplant evaluation is complete and all your results are received, the selection committee meets to determine if you are ready to be placed on the Transplant List—“The List.” If the transplant team determines that you are a candidate for a kidney transplant, additional testing or physician consultations may be required. We will let you know.

You will then have a meeting with your transplant team to discuss its decision regarding your eligibility. There is a tremendous amount of information discussed at this meeting, and you will have a lot to consider concerning your health and what is best for you. Ask as many questions as necessary. In fact, we encourage you to bring your family to this meeting so that everyone's questions can be answered.

Even if the team decides you are a good candidate for transplant, the final decision to proceed always rests with you.
Once you’ve been placed on the transplant list, you begin a period of waiting to be matched with a donor. Because there are many people waiting, and a serious shortage of donor organs, the waiting period can be quite long. It can range from several months to several years. There really is no way to predict how long your wait will be. There is no such thing as “the top of the list.” The order of the list changes with every kidney that becomes available and is dependent on blood type, tissue type and crossmatching results. The length of time you may wait will depend on your blood type and crossmatch reactivity to individual donors.

Of all the stages in the transplant process, the waiting period is perhaps the most challenging. For statistical averages of waiting times for each type of organ, visit www.unos.org.
Multiple Listing means that you are registered on the waiting list of more than one Transplant Center. It is possible that multiple listing may increase your chances of getting an organ offer earlier. Discuss this option with your Transplant Team. Ultimately, it is up to the specific Transplant Center to decide whether to accept you for multiple listing and it will most likely involve another full evaluation by their team. Check with your Insurance Company first to be sure that they will cover the additional testing.
While you are waiting for your match is the perfect time to take care of a whole host of preparatory details. For example, develop a financial plan and a family support plan for when you are in the hospital and when you are recovering at home. Be sure to stay healthy and active. Talk to your team about diet, exercise and what you can do to stay as fit as possible. You should also pack a bag and prepare a plan for getting to the hospital and contacting family members. It is important to stay in close contact with your Transplant Team during this time. Be sure they are informed of any health changes because your health affects your ability to have a transplant. Let your Transplant Coordinator know about any trips you take out of town so the team will be able to locate you if an organ becomes available.

While you are on the waiting list you need to do the following:
- Attend our pre-transplant class – a schedule will be given to you
- Stay as healthy as you can
- Keep in touch with the Kidney Transplant Team
- Notify us of any telephone, address or insurance changes
- Have a small suitcase packed with toiletries, robe, slippers, etc.
- Contact the Kidney Transplant Team if you are going out of town, and where you can be reached
- Contact the Kidney Transplant Team if you have had a blood transfusion

Living Donation

Living donor kidney transplantation has been done successfully in the United States since the late 1950's. There are several advantages of a living-related donor or a living unrelated donor transplant over cadaveric donor transplants.
- The waiting time is shorter. (The average waiting time, depending on blood type for a cadaveric renal transplant, in this region is up to five years.) A living-related or a living-unrelated transplant can be scheduled for a time that is convenient for both the donor and the recipient.
- Kidneys transplanted from living donors tend to work right away
- Kidneys transplanted from living related and living unrelated donors last longer than kidneys transplanted from cadaveric donors
At Crozer Health, the Living Donor Advocacy Service is made up of skilled professionals who have special knowledge about living donation, transplantation, medical ethics and informed consent. These professionals are not on The Kidney Transplant Program staff and are therefore in a unique position to be more objective about and supportive of you as a living donor. Their role is to protect the living donors from making decisions that they might not want to make or that they don’t fully understand.

You will be asked if you would like to speak with a Living Donor Advocate. If you do, a Living Donor Advocate will arrange to speak with you to discuss your unique circumstances and to make sure that you are well informed before you make any decisions. The Living Donor Advocate is your advocate and looks out for your best interests. He or she will avoid contact with your intended recipient so that there is no conflict of interest or accidental breach of confidentiality.

Your Living Donor Advocate’s responsibilities include making sure that:
- You understand what the doctors, nurses and other transplant team members are telling you about living donation,
- You are well informed about living donation so that if you do decide to consent to donate, that you do so after careful consideration and with good information.
- You are not experiencing any pressure or other inappropriate encouragement to donate.
- You can ask any question and get honest and clear answers with complete privacy and confidentiality.
Even though the Living Donor Advocate is not a member of the Kidney Transplant Team, he or she will provide the team with enough information about your case so that the team is confident that you are under the care of the advocate. Any information shared will be done so in your best interest and according to the patient information privacy laws of the Commonwealth of Pennsylvania.
Informed Consent is a safeguard for the living donor, designed to protect the living donor’s patient rights. If you decide to become a Living Donor, you will be required to read, understand and sign a Living Donor Consent form that confirms your understanding of the issues surrounding Live Donation.

As part of these protocols, you will be assigned an Independent Donor Advocate (IDA) who is independent of the transplant patient’s medical team. Your independent donor advocate looks out and advocates for your needs, rights, and interests and helps you understand the informed consent, evaluation, surgery and follow-up processes.

This Living Donor Kit contains Crozer Health’s Informed Consent Form for Kidney Transplant/Living Donation. Your independent donor advocate will review the Informed Consent with you and answer any questions that you may have. In fact, don’t hesitate to ask your Independent Donor Advocate and any other Kidney Transplant Center staff any questions you have.
Crozer Health performs all types of living donor transplants, including:

Direct Donation

One of the most common types of kidney donation is the direct, or living related/living unrelated, donation. This is the fastest way to get your new kidney, often without the need for dialysis. Unfortunately, they don’t always work out. While most common, the majority of potential donors interested in the direct donation are incompatible with their intended recipient because they must pass a very sensitive and complicated crossmatch test, tissue matching and be blood compatible before the transplant can occur.

Fortunately, if the donor and recipient are not a good match, they can participate in the Paired Exchange program.

Paired Exchange Donation

Often, recipients and their donors aren’t a good match because of incompatibility with their blood types or they have antibodies that do not work well together. These antibodies can severely harm your new kidney after transplantation and lead to rejection or sever infection. That’s where Paired Exchange Donation can be beneficial.

Paired exchange donation may be an option if you've found someone willing to donate a kidney but the donor's kidney is incompatible with your blood or you're sensitive to their antibodies. Rather than donating a kidney directly to you, your donor may give a kidney to a person whose blood and tissue is compatible with the donor's kidney, and you receive a kidney from the other recipient’s donor. When both individuals are ready for surgery, the transplants will be scheduled for the same day.

Anonymous Donation

The gift of an organ can save the life of a transplant candidate and the experience of providing this special gift to a person in need can serve as a very positive aspect of the donation. Currently, living anonymous kidney donation is the best option to expand the kidney donor pool in the United States and is done willingly and with no financial gain. Thousands of people die each year waiting for a compatible donor. Fortunately, there are these good Samaritans out there who are willing to risk their own quality of life to save the life of someone in need.

Anonymous donation is not only good for the recipient but also potentially good for the donor Very few people are given the opportunity to be a hero. This type of donation provides the donor with a sense of truly contributing to society in a heroic and immeasurable fashion. The living anonymous donor saves a patient from life on dialysis and provides hope for the future for someone in despair. This is psychologically uplifting and affirming for the donor.
While many people are willing to be living donors, not everyone has the qualities necessary to participate in living donation. Donors must be chosen carefully in order to avoid outcomes that are medically and psychologically unsatisfactory. If you are considering being a living organ donor, it’s important to educate yourself about the donation process, required testing, financial considerations, risks and recovery.

At a minimum, all potential living donors must be genuinely willing to donate, physically fit, in good general health, and free from high blood pressure, diabetes, cancer, kidney disease and heart disease. Individuals considered for living donation are usually between 18-60 years of age. Gender and race are not factors in determining a successful match. The living donor must first undergo a blood test to determine blood type compatibility with the recipient. If the donor and recipient have compatible blood types, the donor undergoes a medical history review and a complete physical examination.

A living donor can be:
- Family, friend, spouse or coworker;
- A directed altruistic donor (someone who donates a kidney to a specific person with whom he or she might be acquainted);
- A non-directed altruistic donor (someone who donates a kidney to a non-specific person on the waiting list);
- A donor through the Paired Donor Exchange program. This is a person who is willing to donate but is incompatible to the intended recipient.
If you are interested in being a living donor, you should contact the Crozer Health Medical Center Living Donor Kidney Program at 610-619-8420 to request a questionnaire. Once the questionnaire is completed, it is reviewed by a nurse coordinator and a determination is made regarding the Kidney/Donor Evaluation process.

The decision to become a living donor involves careful consideration and is a completely voluntary one. If you are considering being a living organ donor, it’s important to educate yourself about the donation process, required testing, financial considerations, risks and recovery. It is also important to know that you may change your mind at any time during the process. Your decision and reasons are kept confidential.

At Crozer Health, an independent third party, called a “Patient Navigator,” can help you explore your interest in, and feelings about, being a living donor and to help you assess your emotional and financial preparedness for living donation. Our Patient Navigators are not on The Kidney Transplant Program Staff and are therefore in a unique position to be more objective about and supportive of you as a living donor. They are also very skilled and have extensive knowledge about living donation, transplantation, medical ethics and informed consent.
You can still donate. Your transplant team can arrange for your donor assessment and kidney evaluation to take place at a transplant center near you if that is more convenient. Usually the donation will take place in the hospital where the person you are donating to is being cared for. If other arrangements are necessary, be sure to talk to the transplant team ahead of time.
Each assessment is unique and the length of time can vary. In general, the Evaluation Process will take between two to six weeks to complete, including our evaluation of your test results.

As a potential living donor, you first undergo a blood test to determine blood type compatibility with the recipient. If the donor and recipient have compatible blood types, the next step for the donor is a medical history review and a complete physical examination. In the examination, doctors may perform the following tests:
- Tissue Typing: The potential living donor’s blood is drawn for tissue typing of the white blood cells. This test checks the tissue match between six codes on the potential living donor and recipient cells. While still required as part of the transplant process, tissue typing is rarely a consideration for living organ donation.
- Crossmatching: A blood test is done before the transplant to see if the potential recipient will react to the potential living donor’s organ. Although each test is an important part of kidney selection, the crossmatch is the most important test. To receive a kidney transplant, you must have a compatible crossmatch with the donor. If the crossmatch is "positive," then the donor and patient are incompatible because antibodies will immediately react against the donor’s cells and consequently cause immediate loss of the transplant. If the crossmatch is "negative," then the transplant may proceed. Crossmatching is routinely performed for kidney and pancreas transplants.
- Antibody Screen: An antibody is a protein substance made by the body's immune system in response to an antigen (a foreign substance; for example, a transplanted organ, blood transfusion, virus, or pregnancy). Because the antibodies attack the transplanted organ, the antibody screen tests for panel reactive antibody (PRA). The white blood cells of the potential living donor and the serum of the recipient are mixed to see if there are antibodies in the recipient that react with the antigens of the donor.
- Blood tests to screen for transmissible diseases: These tests determine if a potential living donor has HIV/AIDS, hepatitis and other transmissible diseases.
- Urine Tests: In the case of a kidney donation, urine samples are collected for 24 hours to assess the potential living donor’s kidney function.
- X-Rays: A chest X-Ray and an electrocardiogram (EKG) are performed to screen the potential living donor for heart and lung disease. Depending upon the age and medical history of the potential living donor, other heart and lung tests may be needed.
- Radiologic testing: These tests help physicians view the potentially donated organ, including its blood vessel supply. They can include a CAT scan, MRI, and arteriogram, a set of tests involves injecting a liquid that is visible under X-Ray into the blood vessels to view the organ to be donated.
- Cancer screening: These tests may include a colonoscopy, mammogram, prostate exam, and skin cancer screening. Your transplant team will determine the individual test needs, depending upon the age and medical history of the potential living donor.
- Psychiatric and/or psychological evaluation: Both the potential living donor and the recipient may undergo a psychiatric and/or psychological evaluation. These tests assess the mental health of the potential living donor, whether the donor feels pressure from others to donate, the donor’s ability to understand information and make an informed decision, and the donor’s daily life circumstances (such as the possible impact on a job, whether he/she would have any help while recovering from donation, and the donor’s family’s views about the donation).
- Gynecological examination: For all female donors, a complete gynecological examination is required. For females 32 years and older, a mammogram is also required.
- Final blood test: Usually completed within 48 hours of surgery, the last blood test is another crossmatch. It is the final comparison of the potential living donor’s blood cells and recipient's blood serum to make sure that the recipient has not created any antibodies that would attack the donated organ.
All of these test procedures are usually done on an outpatient basis, but in some cases, testing may require an overnight hospital stay.
The odds are excellent. In fact, living kidney donation has the best track record of all forms of donation. Statistics from the Organ Procurement and Transplant Network show that the kidney donated from living donors is still functioning in 96% cases after one year, 81% of cases after five years, and 58% of cases after 10 years. Even so, you should be prepared mentally for the possibility of rejection.
The surgical procedure itself is called a nephrectomy, the surgical removal of a kidney. This removal can be done by one of two ways: either a Laparoscopic Nephrectomy or an Open Nepherctomy.

Laparoscopic Donor Nephrectomy

Laparoscopic Nephrectomy, also known as "keyhole surgery," is a minimally invasive surgical procedure for obtaining a kidney from a living donor that can make the process easier.

In this procedure, the surgeon makes two or three small incisions close to the belly button. The kidney is removed through the central incision. Through one of the other openings, a special camera called a laparoscope is used to produce an inside view of the abdominal cavity. Surgeons use the laparoscope, which transmits a real-life picture of the internal organs to a video monitor, to guide them through the surgical procedure.

In comparison to the standard, Open Nephrectomy operation, Laparoscopic Nephrectomy results in a smaller incision, reduces recuperation time and usually shortens hospital stays. Many donors are discharged from the hospital after two days and return to normal activity within four weeks.

Not all donors can undergo Laparoscopic Nephrectomy. You may not qualify for the procedure if:
- You have had multiple previous abdominal surgeries
- You are significantly overweight
- There is abnormal anatomy of the kidney
The Kidney Transplant Team, in conjunction with your doctor, will complete an evaluation to determine if laparoscopic donor nephrectomy is a possibility.

Open Nephrectomy

Open Nephrectomy has been the standard for the last 35 years and involves a five to seven-inch incision on the side of the chest and upper abdomen. A surgical instrument called a retractor is usually needed to spread the ribs to gain access to the donor's kidney. Sometimes, it's necessary to remove part of a rib for better exposure. The operation typically lasts three hours, and the recovery in the hospital averages four to five days. Donors can usually return to normal activity within four to twelve weeks.
The Transplant Team surgeons have performed more than ___ laparoscopic nephrectomies (surgical removal of a donor kidney from a living donor). Additionally, our team has been very actively and intimately involved in developing best practices for laparoscopic nephrectomy since the procedure’s introduction.
Both you and your recipient will be admitted to the hospital the morning of the scheduled procedure. All pre-operative testing will have been completed, so you and your recipient will proceed to the surgery center. Once there, the staff will start an intravenous (IV) line through which fluids are administered. You will then meet with your surgeon who will answer any remaining questions and will have you complete a consent form for the procedure.

A patient navigator will then escort you to the operating room when it is time for surgery. Shortly after arriving in the operating room, the anesthesiologist will give you sedation medicine through the IV, and a urinary catheter will be inserted into the bladder. Shortly thereafter, the surgery will begin.
Following surgery, you will wake up in the recovery room feeling groggy and a little uncomfortable. This is normal. You will be administered pain medication and closely monitored. You will also have a catheter that drains urine to a collecting bag in order to monitor your remaining kidney’s urine output. This catheter will remain in overnight and is usually removed the next day. Patients are encouraged to get out of bed, usually several hours following surgery, and walk around. It is not uncommon for donors to experience gas pain and bloating after the surgery, but walking should help alleviate your discomfort.

After discharge from the hospital, you will have a post-operative appointment with your surgeon 1-2 weeks after the surgery. Additional follow-up appointments will be scheduled 6 months, 1 year and 2 years after your donation. This will allow our team to monitor your kidney function. After your 2-year follow-up with the transplant center, we recommend annual check-ups.
Of course. You are asked to pick one person as the family spokesperson who will interact with the doctors and nurses about your condition while you are in surgery and after surgery when you are not able to communicate on your own. We will select the legal next of kin unless you indicate otherwise. Your family spokesperson can call the Kidney Transplant Center office for information and questions at 610-619-8420. Once you are out of the ICU and feeling better, our primary communication will be with you.
Depending upon whether your surgery is a Laparoscopic Nepherctomy or an Open Nephrectomy, donors usually stay in the hospital between a few days and a week after surgery. Although recovery time varies, most kidney donors return to normal activities after four to six weeks, depending on the physical demands of your daily living and work tasks. You may not be able to drive for up to two weeks. You may have lifting restrictions for at least six weeks. It is important to talk to the Kidney Transplant Team about what to expect.

You will also have multiple follow-up office visits and laboratory tests with the Kidney Transplant Team up to a year after the surgery. Unless unexpected complications occur, you can then schedule regular visits with your family doctor. It’s important to attend all appointments to make sure that you are recovering appropriately. The information collected during the follow-up process is also critical to help future potential living donors to make informed decisions.

Your Independent Donor Advocate and Kidney Transplant Team are good sources for medical information about the living donor surgery and recovery process. Please talk with these professionals to understand what to expect, although the surgery and recovery process can differ among living donors.
Typically, donors usually stay in the hospital between a few days and a week after surgery. Your Independent Donor Advocate and Kidney Transplant Team are good sources for medical information about the living donor surgery and recovery process. Please talk with these professionals to understand what to expect, although the surgery and recovery process can differ among living donors.
Living donation involves anesthesia and major surgery and their associated risks. As with any major operation, there are risks involved. For example, all patients experience some pain and discomfort after a surgical procedure. Although each situation is different, donors typically have a rapid and uneventful post-operative course. The first twenty-four hours after surgery, the donor is usually sleepy and tired, a natural reaction to surgery and anesthesia.

It is possible for kidney donors to develop infections or bleeding. Other surgical complications can include pain, infection, blood loss (requiring transfusions), blood clots, allergic reactions to anesthesia, pneumonia, injury to surrounding tissue or other organs and even death.

Please note that there has been no national systematic long-term data collection on the risks associated with living organ donation. Based upon limited information that is currently available, overall risks are considered to be low, but risks can differ among donors.

Some possible risks of kidney donation may include high blood pressure (hypertension); large amounts of protein in the urine; hernia; organ impairment or failure that leads to the need for dialysis or transplantation; and even death. There may be other medical risks for organ donation surgery since there are limited data about long-term complications and since each donor’s surgery and recovery experience is unique.

Are there any psychological risks

In addition to potential individual health concerns, it is possible for negative psychological consequences to result from living donation. Negative psychological symptoms are possible during the healing process and even years after the donation. For example, depression and anxiety after donation are common concerns and often attributed to the healing process of surgery, renewed family demands and an attention shift from the donor onto the recipient. As a result, you may have feelings of regret, resentment, or anger. Scarring or other aspects of the donation process could possibly contribute to problems with body image, and as with any transplant, there is also the risk that the recipient will have problems such as infection, rejection of the organ or even death. For a living donor, the news of such problems can be devastating. Treatment for these conditions can be lengthy, costly, and could possibly include the use of medications with their own risks and side effects.

The best source of information about expected donor outcomes is your Kidney Transplant Team and your Independent Donor Advocate. You should discuss these risks with these professionals. In addition, it’s important to take an active role in learning more about these potential surgical risks and long-term complications:

What are the positive aspects of living donation

On the positive side, the gift of an organ can save the life of a transplant candidate. The experience of providing this special gift to a person in need can serve as a very positive aspect of the donation. Some donors have reported positive emotional experiences, including feeling good about improving another person’s life. Transplants can greatly improve recipients’ health and quality of life, allowing them to return to normal activities. They can spend more time with family and friends, do more physical activities, and pursue interests and hobbies.

A living donor makes it possible to schedule the transplant at a time that is convenient for the donor and the transplant candidate. Better genetic matches between living donors and recipients may decrease the risk of organ rejection. In addition, kidneys from living donors usually work immediately in recipients in comparison to kidneys from deceased donors.

A living donor also removes a candidate from the national transplant waiting list, which currently includes more than 100,000 people. Based upon the most recent OPTN data, about 11% of kidney candidates added to the waiting list in 2007 received a kidney within one year. About a third of candidates added to the waiting list in 2003 received a kidney within five years. In 2008, more than 4,500 kidney transplant candidates died while waiting on the list.
The transplant recipient’s insurance will cover your general expenses as a donor, such as the evaluation, surgery, and limited follow-up tests and medical appointments. However, the recipient’s insurance may not cover follow-up services for you if medical problems occur from the donation. Your own insurance may not cover these expenses either. Additionally, the recipient’s insurance coverage usually does not include transportation, lodging, long distance phone calls, childcare, or lost wages.

Further, all transplant centers must turn in follow-up forms on living donors for two years after the donation surgery. Generally, anything that falls outside of the transplant center's donor evaluation is not covered. It is important to ask your transplant team about the costs follow-up care. These costs could include annual physicals, travel, lodging, lost wages and other non-medical expenses. Although it is against the law to pay a living donor for the organ, these costs may be covered by the recipient.

Be sure to check your specific insurance policy or ask the Kidney Transplant Center’s financial coordinator about concerns related to your specific circumstances. You may also want to learn more about the National Living Donor Assistance Program, which provides financial assistance to those who want to donate an organ.

You should talk about any financial concerns with the Kidney Transplant Center Team. They may have resources available for you. You might also consider contacting the National Living Donor Assistance Center at (703) 414-1600 or www.livingdonorassistance.org. This service may be able to provide financial help for travel, lodging, meals, and other non-medical expenses connected with your evaluation, surgery, and follow-up services (within 90 days after the donation).
Living donors are typically responsible for any time lost from work, unless their employer is able to provide paid leave or allow the donor to use short-term disability. Similarly, if you carry your own short-term disability insurance coverage, check with your insurance carrier prior to making your decision to become a living donor.

Additionally, employees of the Federal government receive 30 days paid leave for organ donation, in addition to their sick and annual leave (under HR 457), and many states have passed laws that make it easier to become a living donor by providing time off for state and/or private sector employees. Some states also offer tax deductions or credits for travel expenses and time away from work. And in other states, legislation has only been introduced, but not signed into law.

Also, talk with your Transplant Financial Coordinator about medical and disability insurance that provides coverage for problems that may occur from the donation. Some centers may provide these services free of charge, while others may offer them for purchase.
While you will have multiple follow-up office visits and laboratory tests with the Kidney Transplant Team up to a year after the surgery, your life should return to normal fairly quickly. After the first year, unless unexpected complications occur, you will return to the care of your family doctor. It’s important to attend all appointments to make sure that you are recovering appropriately.

Although recovery time varies, most kidney donors return to normal activities after four to six weeks, depending on the physical demands of your daily living and work tasks. You may not be able to drive for up to two weeks. You may have lifting restrictions for at least six weeks. It is important to talk to the Kidney Transplant Team about what to expect.
This is something potential donors should discuss with the transplant team. Talk to your transplant team about any pre-existing condition or other factors that may put you at a higher risk of developing kidney disease, and consider this carefully before making a decision about donation. There have been some cases in which living donors needed a kidney later, but not necessarily as a result of the donation itself. It is considered a potential risk of donation, and consider this carefully before making a decision about donation. Presently, UNOS policy gives four extra points on the local (not national) waiting list to living donors.
Although studies have shown that kidney donation does not affect the completion of a safe pregnancy and childbirth, it is typically recommended to wait to become pregnant at least six months after surgery. Be sure to talk with your physician or gynecologist about your interest in donation and the effect it could have on future pregnancies.
The ability to obtain health and life insurance coverage after you have become a living donor is not restricted by most insurance companies, but your premiums could increase. However, there have been some instances in which living donors had difficulty changing insurance carriers after the donation, due to higher premiums or a pre-existing waiting period, and some donors have reported difficulty in getting, affording, or keeping health, disability, or life insurance. If you do not have health insurance, serving as a donor could be considered a pre-existing condition if you apply for insurance later.

It is important to talk to the financial counselor and social worker at the Kidney Transplant Center to find out if donation will affect your health or life insurance coverage. You should also talk with your insurance agent. If you work, talk with your employer about any existing leave policies before committing to living donation. Also, fully think about the financial impact on your family, especially if you and/or whoever serves as your caregiver during the donation recovery process may face lost wages and personal hardship.

Kidney Transplant

Transplantation eliminates the need for dialysis and helps patients enjoy a life filled with more freedom, energy and productivity. Although most patients are on dialysis before first being evaluated for transplantation, patients with end-stage renal disease can be referred for transplantation even before starting dialysis.

Successful kidney transplantation treats your kidney failure and gives you back your health. It also provides a better quality of life and is therefore a preferable treatment for many patients. Usually you will have fewer restrictions on fluid intake and diet after receiving a transplant. Many patients also return to work and lead a full life after transplant.
Kidney transplant surgery is major surgery, and as such, carries a risk of significant complications, including:
- Blood clots
- Bleeding
- Leaking from or blockage of the tube (ureter) that links the kidney to the bladder
- Failure of the donated kidney
- Rejection of the donated kidney
- Increased risk of high blood pressure, diabetes, cataracts, stomach ulcers and infection
Healthy kidneys clean your blood by removing excess fluid, minerals, and wastes. They also make hormones that keep your bones strong and your blood healthy. When your kidneys fail, harmful wastes build up in your body, your blood pressure may rise, and your body may retain excess fluid and not make enough red blood cells. When this happens, you need dialysis to do the work of your failed kidneys. There are two main types of dialysis used to treat end-stage renal failure, CAPD and CCPD:
- Continuous Ambulatory Peritoneal Dialysis (CAPD) - If you choose CAPD, you'll drain a fresh bag of dialysis solution into your abdomen. After 4 to 6 or more hours of dwell time, you'll drain the solution, which now contains wastes, into the bag. You then repeat the cycle with a fresh bag of solution. You don't need a machine for CAPD; all you need is gravity to fill and empty your abdomen. Your doctor will prescribe the number of exchanges you'll need, typically three or four exchanges during the day and one evening exchange with a long overnight dwell time while you sleep.
- Continuous Cycler-Assisted Peritoneal Dialysis (CCPD) - CCPD uses an automated cycler to perform three to five exchanges during the night while you sleep. In the morning, you begin one exchange with a dwell time that lasts the entire day.
The type of dialysis you choose will depend on the schedule of exchanges you would like to follow, as well as other factors. You may start with one type of dialysis and switch to another, or you may find that a combination of automated and nonautomated exchanges suits you best. Work with your physician and healthcare team to find the best schedule and techniques to meet your lifestyle and health needs.
Because you never know where you will be when you get “The Call,” it is important to always be ready. The Kidney Transplant Team must have a list of contact phone numbers for you so they can reach you 24-hours a day. Carry your beeper with you at all times. Keep your cell phone with you (even when sleeping) and be sure that the ringer is always turned on. Update the Kidney Transplant Team if you go on a trip. Upon your return, call the Transplant Coordinator to update your status. Again, it is your responsibility to be available. Your place on the waiting list may be jeopardized if we cannot reach you and you cannot get here in a timely fashion.
Have a small bag packed (or at least, a list of what you need to pack) with toiletries, a pillow, comfortable clothes, spare glasses, books or crossword puzzles. You will not need anything until you come out of the Intensive Care Unit at the conclusion of your surgery, at which time your family can bring your personal items. Make sure that your family knows where your packed bag is so that they can bring it when it’s time.

Beyond your personal items, there are a number of other things that you’ll need to have:
- Insurance Information: You must bring all insurance information, forms and cards as proof of current insurance coverage, and if required, you must obtain a pre-certification or referral prior to admission.
- Medication List: A list of all medications that you are taking (but do NOT bring medications from home)
- Power of Attorney or Guardianship: Designate a power of attorney or guardianship if your next of kin is not capable of this responsibility. This designation must consist of a comprehensive plan and be notarized. Our Social Worker will guide you through this process. The designee must be someone you can trust to follow your wishes and act in your best interest in the event that you are not capable. The designee does not have to be your next of kin. Your designee's name must be included on all your bank accounts, safety deposit boxes, and other financial and personal records.
- What Not to Bring: Do not bring televisions, laptop computers, large radios, computer games or electrical appliances. Do not bring money, credit cards, jewelry, flowers/plants, pets, fresh fruit or vegetables, large suitcases, clothes or children less than 14 years of age. Also, be sure to ask your family to take your possessions and valuables home. Crozer Health cannot be responsible for valuables unless they are locked in the hospital safe.
Perhaps. Crozer Health takes part in a number of different clinical trials. But the decision to participate is always yours— it is very important to know that you do not have to agree to be involved in any experimental procedures or investigational studies. If the transplant team asks you to be involved in any clinical trials, experimental procedures or investigational studies, be sure to ask insurance company if your insurance policy will cover the payment. If you have questions, ask the transplant team.
Of course. You are asked to pick one person as the family spokesperson who will interact with the doctors and nurses about your condition while you are in surgery and after surgery when you are not able to communicate on your own. We will select the legal next of kin unless you indicate otherwise. Your family spokesperson can call the Kidney Transplant Center office for information and questions at 610-619-8420. Once you are out of the Step Down Unit and feeling better, our primary communication will be with you.

Recovery

After your transplant, you will wake up in Recovery Room of Crozer’s Operating Room and will then be transferred to the Step Down Unit. You will be closely monitored while in the Step Down Unit. The average stay in the unit varies but averages a few days, individualized according to your needs. Your family will be allowed to visit with you in the Step Down Unit.

Infection and rejection are serious concerns with any organ transplant. Taking precautions to prevent infection and rejection will be started as soon as you are moved to the Step Down Unit. Medications and fluid will be given to you through an IV for the first few days after your transplant. You will then learn your medications and how to care for your transplanted kidney.

The average time in the hospital after an uncomplicated kidney transplant is six to seven days.
Patients are transferred to the Step Down Unit after surgery so that we can keep a close watch on you and your condition following surgery. Infection is a serious concern. Taking precautions to prevent infection and rejection will be started as soon as you are moved to the Step Down Unit. Medications and fluid will be given to you through an IV for the first few days after your transplant. You will then learn your medications and how to care for your transplanted kidney.
After you leave the hospital, close monitoring is necessary for a few weeks. Your transplant team will develop a checkup schedule for you.

We will follow you closely for the first few weeks. You will receive an appointment for your next visit to the Kidney Transplant Center and for a procedure to remove a tube in your bladder. We will also give you instructions for lab work or other tests that you might need in order to monitor your progress and identify complications as soon as possible. You should bring your medications and this manual to all of your appointments.

For the first month after your transplant, you will have regularly scheduled follow-up appointments at the Kidney Transplant Center. These visits will be more frequent during the first year after surgery and will gradually decrease over the next few months. After three months or so, you will return to your regular doctor for follow up care. The appointments will involve routine check-ups and blood tests to monitor your progress and to be sure that your body does not reject the organ. Of course, you should always call the Kidney Transplant Team at any time if you are feeling sick or even if you just have questions.

During this time, if you do not live within an easy drive of Crozer Health, you may need to make arrangements to stay close to the transplant center.
Routine exams, blood work, laboratory testing and frequent clinical visits are necessary to a successful recovery. Prepare for at least two to three visits to the clinic each week to have blood drawn and participate in a thorough review of your recovery progress. These tests will determine whether or not your current medications are appropriate or need to be adjusted.

The main test used to monitor your new kidney is serum creatinine. A creatinine test reveals important information about your kidneys. Creatinine is a chemical waste product that's produced by your muscle metabolism and to a smaller extent by eating meat. Healthy kidneys filter creatinine and other waste products from your blood. The filtered waste products leave your body in your urine. If your kidneys aren't functioning properly, an increased level of creatinine may accumulate in your blood. A serum creatinine test ultimately measures the level of creatinine and gives you an estimate of how well your kidneys filter waste. Your doctor will provide a thorough review of the results for this tests and provide a direct course of action as necessary.

Beyond the standard blood and creatinine tests, monthly breast and testicular self-examinations are highly recommended, along with yearly PAP smears, breast exams, testicular exams, and skin cancer screenings. Studies have shown that taking immunosuppressive medications can increase your likelihood of developing certain types of cancers. It is imperative that you talk with your doctor to schedule these examinations and to discuss any questions you may have regarding early detection of these types of cancers.

As you progress through your recovery, the need to visit the Kidney Transplant Center will be less frequent, and you’ll eventually be referred back to your primary care provider and/or nephrologist for long-term care.
You will take a complex regimen of medications when you leave the hospital and for the rest of your life. You may take many different drugs several times a day, including powerful immunosuppressants and steroids, which can have significant side effects. You will also take several drugs to alleviate these side effects. It is critical that you learn about your medications and develop a system to take them exactly as prescribed. Taking these medications is the single most important thing to do in order to prevent rejection and they must be taken as directed. Not taking the medications immediately or missing doses will cause damage to, and eventual loss of, your new kidney.

The medications fall into nine main categories:
- Immunosuppressants (or “anti-rejection” medications): These medications are designed to suppress (or lower) your immune system and lessen the chance of kidney rejection.
- Steroids (the first line of defense for rejection): These medications are also designed to lessen the chance of kidney rejection and will quickly be reduced to low doses.
- Antivirals/antibacterials: These medications help your body prevent viral, bacterial and fungal infections.
- Antihypertensive: These medications, although used to treat high blood pressure, will improve blood flow to your new kidney.
- Cholesterol lowering agents: These medications are designed to lower and manage Cholesterol in your system.
- Diuretics: Also known as “water pills,” these medications help control fluid buildup.
- Various medications to help prevent stomach ulcers.
- Various medications to counter side effects of the immunosuppressants.
- Vitamins and minerals
Perhaps. It depends upon the nature of the complication. Throughout your post-transplant recovery, your Transplant Coordinator will be available by telephone to answer any questions—and there is no such thing as a "silly" or "dumb" question. Many important phone numbers are listed in your Discharge Guide. Feel free to call them at any time.
Patients usually return to work within 60 to 90 days. But it is extremely important to alert your employer to the potential conflicts that post-operative testing could produce in the workplace. For example, patients may need to be treated for unforeseen rejection or other problem, resulting in additional time off work. It may be best to initially resume your work on a part-time basis or with a flexible schedule until you have a better understanding of how well your recovery process is going.

Ultimately, the decision of when to return to work or school is entirely up to you. If you have questions or any doubts about whether or not you are ready, sit down with your employer and/or family and develop a return strategy.
Kidney transplant patients, on average, cannot drive for up to four weeks following the surgery. Post-operative medications generally cause drowsiness, weakness, blurred vision and hand tremors and could make handling a motor vehicle very difficult. Please do not attempt to drive a vehicle without the consent and clearance of the transplant team.

FAQ: Life After Transplant

A very common question. While a kidney transplant may allow you to have a better quality of life, free of dialysis, it is not a cure. It is an ongoing treatment that requires a lifetime commitment full of medications, doctor visits and tests. It will, however, provide you with a better lifestyle, more energy and should provide you with a level of self-worth that you may not have had while on dialysis.
After you leave the hospital, close monitoring is necessary for a few weeks. Your transplant team will develop a checkup schedule for you.

We will follow you closely for the first few weeks. You will receive an appointment for your next visit to the Kidney Transplant Center and for a procedure to remove a tube in your bladder. We will also give you instructions for lab work or other tests that you might need in order to monitor your progress and identify complications as soon as possible. You should bring your medications and this manual to all of your appointments.

For the first month after your transplant, you will have regularly scheduled follow-up appointments at the Kidney Transplant Center. These visits will be more frequent during the first year after surgery and will gradually decrease over the next few months. After three months or so, you will return to your regular doctor for follow up care. The appointments will involve routine check-ups and blood tests to monitor your progress and to be sure that your body does not reject the organ. Of course, you should always call the Kidney Transplant Team at any time if you are feeling sick or even if you just have questions.

During this time, if you do not live within an easy drive of Crozer Health, you may need to make arrangements to stay close to the transplant center.
Routine exams, blood work, laboratory testing and frequent clinical visits are necessary to a successful recovery. Prepare for at least two to three visits to the clinic each week to have blood drawn and participate in a thorough review of your recovery progress. These tests will determine whether or not your current medications are appropriate or need to be adjusted.

The main test used to monitor your new kidney is serum creatinine. A creatinine test reveals important information about your kidneys. Creatinine is a chemical waste product that's produced by your muscle metabolism and to a smaller extent by eating meat. Healthy kidneys filter creatinine and other waste products from your blood. The filtered waste products leave your body in your urine. If your kidneys aren't functioning properly, an increased level of creatinine may accumulate in your blood. A serum creatinine test ultimately measures the level of creatinine and gives you an estimate of how well your kidneys filter waste. Your doctor will provide a thorough review of the results for these tests and provide a direct course of action as necessary.

Beyond the standard blood and creatinine tests, monthly breast and testicular self-examinations are highly recommended, along with yearly PAP smears, breast exams, testicular exams, and skin cancer screenings. Studies have shown that taking immunosuppressive medications can increase your likelihood of developing certain types of cancers. It is imperative that you talk with your doctor to scheduled these examinations and to discuss any questions you may have regarding early detection of these types of cancers.

As you progress through your recovery, the need to visit the Kidney Transplant Center will be less frequent, and you’ll eventually be referred back to your primary care provider and/or nephrologist for long-term care.
You will take a complex regimen of medications when you leave the hospital and for the rest of your life. You may take many different drugs several times a day, including powerful immunosuppressants and steroids, which can have significant side effects. You will also take several drugs to alleviate these side effects. It is critical that you learn about your medications and develop a system to take them exactly as prescribed. Taking these medications is the single most important thing to do in order to prevent rejection and they must be taken as directed. Not taking the medications immediately or missing doses will cause damage to, and eventual loss of, your new kidney.

The medications fall into nine main categories:
- Immunosuppressants (or “anti-rejection” medications): These medications are designed to suppress (or lower) your immune system and lessen the chance of kidney rejection.
- Steroids (the first line of defense for rejection): These medications are also designed to lessen the chance of kidney rejection and will quickly be reduced to low doses.
- Antivirals/antibacterials: These medications help your body prevent viral, bacterial and fungal infections.
- Antihypertensive: These medications, although used to treat high blood pressure, will improve blood flow to your new kidney.
- Cholesterol lowering agents: These medications are designed to lower and manage Cholesterol in your system.
- Diuretics: Also known as “water pills,” these medications help control fluid buildup.
- Various medications to help prevent stomach ulcers.
- Various medications to counter side effects of the immunosuppressants.
- Vitamins and minerals
Perhaps. It depends upon the nature of the complication. Throughout your post-transplant recovery, your Transplant Coordinator will be available by telephone to answer any questions—and there is no such thing as a "silly" or "dumb" question. Many important phone numbers are listed in your Discharge Guide. Feel free to call them at any time.
Patients usually return to work within 60 to 90 days. But it is extremely important to alert your employer to the potential conflicts that post-operative testing could produce in the workplace. For example, patients may need to be treated for unforeseen rejection or other problem, resulting in additional time off work. It may be best to initially resume your work on a part-time basis or with a flexible schedule until you have a better understanding of how well your recovery process is going.

Ultimately, the decision of when to return to work or school is entirely up to you. If you have questions or any doubts about whether or not you are ready, sit down with your employer and/or family and develop a return strategy.
Kidney transplant patients, on average, cannot drive for up to four weeks following the surgery. Post-operative medications generally cause drowsiness, weakness, blurred vision and hand tremors and could make handling a motor vehicle very difficult. Please do not attempt to drive a vehicle without the consent and clearance of the transplant team.
Beyond the obvious health benefits, we strongly recommend that you either do not begin to smoke or that you quit immediately. Smoking diminishes your red blood cells' ability to carry oxygen, so less oxygen reaches all of your tissues and this decreases your ability to heal. Smoking also narrows your blood vessels, especially those in your legs, arms, and heart. It also increases the acid in your stomach and can delay or prevent the healing of any ulcers you may develop. All of these problems are even more serious in individuals taking immunosuppressive medications. Finally, smoking can damage the lungs and put you at a much greater risk of developing lung infections, such as bronchitis, emphysema, and pneumonia, and cancer, a leading cause of death among transplant patients.
Following kidney transplantation, men will typically have far fewer problems with impotence and women may resume their normal menstrual cycle, with chances for pregnancy being far greater than it was before surgery. It is important to note, however, that post-operative surgery medications, such as some blood pressure and anti-rejection medications, could still affect your normal sexual functions. Impotence, menstrual irregularities, increased acne, bruising and body hair could all affect the patient either physically or psychologically.

Urinary tract infections (UTI) are another common problem relating to sexual intercourse. Women who are on immunosuppressant medication tend to develop infections much easier since this medication affects the immune system’s ability to fight off infection. To avoid them, be sure to urinate before and after intercourse and drink plenty of fluids (water). If you think you may be suffering from UTI symptoms or have questions about sexual intercourse after transplant, contact your doctor’s office for more information.

Many transplant patients interested in children want to know if it is safe and possible to continue with their plans following the surgery. While childbirth is not recommended within the first year following the transplant, it is important to know that it is possible and you should take all of the necessary precautions to prevent it until your doctor has cleared you for childbirth. Many patients also want to know if having only one kidney will affect a baby born after the transplant surgery. It has been well documented that many healthy babies have been born to both men and women who have received the transplant surgery. However, studies have shown that there is a greater chance to women who have had the procedure that they might lose the baby prior to full-term or their baby will be born smaller. Also, the chances of birth defects do not appear to be any higher or lower than that of the general population at this time.

Your doctor is always the best source of information about these issues. It’s important to discuss and be under the care of one who has the necessary knowledge and experience to assure the best chance of having a normal pregnancy and a healthy baby.
The Kidney Transplant Team at Crozer Health highly recommends that patients do not travel until they are stable and their kidney is functioning properly. Your doctor can help you make a decision on when the right time for travel is. Once your doctor has deemed travel appropriate, the transplant coordinator can provide the names, addresses, and phone numbers of transplant programs in the areas you are going to in case any problems arise. Be sure to carry a list of medications and a medical summary of your procedure and current progress with you when you travel.

We do not recommend travel to under-developed countries, as their availability of high-quality, clean facilities is typically very low. In addition, high-quality food and drinking water may also not be available in these areas, which could lead to risk of serious infection or disease.

Almost any place in the western world and developed areas such as Europe, Australia, Japan, etc. will have the medications and medical expertise to help you in the event that a problem occurs. However, preparedness is the key to travel. Talk with your doctor before you travel to be sure you have everything you need and are properly educated about what to do in the event of an emergency.
Immediately after surgery, your surgical incision will require approximately four to six weeks to heal. Once your doctor has cleared you to begin a non-strenuous exercise program, it’s time to get active. The type and level of exercise you’ll be able to do is strictly dependent on your age, how fit you were prior to surgery, and whether or not you have any underlying medical conditions that may prohibit you from doing certain things. Gentle walks are a great way to get back to doing the things you love again. Take it slow and easy in the beginning. As your condition improves, you’ll be able to walk farther and faster.

Proper diet is important both to the recovery from the transplant operation and to the long-term success of the transplant. Diabetics should continue their typical diet while all other transplant patients should follow a well-balanced diet. Post-op weight gain is always a concern with kidney transplant patients. Expect a significant increase in appetite following the surgery and be sure to watch what you eat and your daily caloric intake.

While each patient is somewhat different, a well-balanced diet containing 1,500 to 2.000 calories a day is generally enough depending on your level of activity and exercise routine.

Many transplant recipients take part in sports in a highly competitive way. The U.S. Transplant Games, sponsored by the National Kidney Foundation, are a testimony to the excellent rehabilitation that results from the combination of a successful transplant and the motivation to get in shape. View additional information about the U.S. Transplant Games.

Financial Issues

Kidney Transplantation is not inexpensive. For that reason, developing a financial strategy is something you cannot start soon enough. The costs associated with transplantation begin long before the actual surgery takes place and continue for the duration of your life after the operation. The costs can add up quickly, but there are many places to turn for aid. You should start working with your Financial Coordinator right away.

Costs can include:
- Medical costs associated with your initial evaluation and testing; the actual surgery; your stay in the Intensive Care Unit after the operation; years of follow-up care, tests and medications.
- Non-medical costs such as transportation for you and your family to and from the hospital before and after the transplant; food, lodging, and long distance phone calls for you and your family; child care; lost wages from work for you or a family member caring for you.
The Estimated U.S. Average Billed Charges per Transplantation during the first year following transplantation are approximately $143,000. The expenses continue for follow-up care and immunosuppressive medications, which can cost over $10,000 a year.

This might seem intimidating but you will have several people helping you put a plan together. The Social Worker on the Kidney Transplant Team will have information on government funding and disability programs. Your Financial Coordinator has detailed knowledge of all the financial options, including insurance. These professionals can help answer many of your questions; but it is always recommended that you explore the details and limitations of your insurance coverage with your insurance company directly.
Generally, as the transplant recipient, your medical insurance (including Medicare) covers the cost of the donor's testing, surgery, and recovery in the hospital. At the same time, any medical treatment needed following the donation, such as annual physical exams, is your (or your donor’s) responsibility and may not be covered. The Financial Coordinator on the Kidney Transplant Team can help answer many of your questions; but it is always recommended that you explore the details and limitations of your insurance coverage with your insurance company directly.
Many Insurance Companies have come to recognize organ transplantation as an acceptable medical treatment for end-stage organ disease and offer some level of coverage for transplants.

Insurance Companies will usually pay a portion of your hospital costs and you will be responsible for the remainder. For example, your policy may cover 80 percent of your hospital costs and you will be responsible for the other 20 percent. You will most likely have deductibles as well as co-payments for medications, doctor's office visits and other medical related expenses.

Most Insurance Companies have a lifetime maximum amount that they will payout to one recipient (often called a "cap"). Once that cap is reached, the insurance company does not have to pay any additional benefits. The amount of the cap varies and how you reach it varies. Sometimes it is based on one procedure and sometimes it is based on all combined procedures and treatments.

Many policies will require a pre-authorization or pre-certification before the transplant procedure. Some require referrals from your Primary Care Physician for each step in your transplant process starting with the tests done in the evaluation phase. Your Financial Coordinator will help you with all the required paperwork. You will want to keep up with your premium payments to ensure that your policy is not at risk of lapsing during this critical time.

Insurance policies vary widely so read yours very carefully to know exactly what portion of the costs will be your responsibility. You may want to talk to someone at your insurance company to answer your questions and help you clearly understand your coverage and options. And of course, keep your Financial Coordinator informed of any changes to your insurance status.

After the surgery, there will be ongoing costs of rehabilitation and medication, both of which may be at least partially covered by insurance. Outpatient pharmacy coverage, sometimes provided by insurance, will help with the cost of the medicines. The Pharma Patient Assistance Directory describes programs offered by pharmaceutical companies to patients who need financial assistance for prescription medications. To request this directory, call 1-800-762-4636.

If, after surgery, you find that you are unable to return to work due to your disability, you may qualify for rehabilitation reimbursement under your plan. There are also commercially available short- and long-term disability insurance coverage plans that may come into play, as well as several government programs that can help you finance your care after transplant.

The Financial Coordinator on the Kidney Transplant Team can help answer many of your questions; but it is always recommended that you explore the details and limitations of your insurance coverage with your insurance company directly.
Medicare is a federal health insurance program available to people age 65 and older or disabled. It offers two basic plans, Part A and Part B. Part A is free and covers many hospital-related expenses like organ transplant surgery. You must pay a premium for Part B, which covers outpatient services including prescription drugs. Like most private insurance plans, Medicare does not pay 100 percent of your costs but you can purchase a private supplemental policy often referred to as “Medigap” to help pay for expenses not covered by Medicare.

Medicaid is a health insurance program run by a state federal partnership and is available to certain low-income patients without health insurance. Individual states decide who is eligible for Medicaid, determine what benefits and services to cover and set payment rates. You usually must reside in the state in which you are having your transplant in order to be covered.

The Financial Coordinator on the Kidney Transplant Team can help answer many of your questions; but it is always recommended that you explore the details and limitations of your insurance coverage with your insurance company directly.
Although many insurance companies offer coverage for transplant costs, the terms and benefits of insurance policies vary widely. Some insurance companies establish network agreements with certain transplant centers; the insurer may pay a higher proportion of costs for centers within their network. In addition, many transplant centers have different policies about the types of insurance they accept for the type of transplant you need.
Many pharmaceutical companies provide medications for patients who are financially needy. For a full directory of programs, including who is eligible and what drugs are covered, visit the Pharmaceutical Research and Manufacturers of America website at www.pharma.org.

Questions to Ask
- Am I eligible for prescription drug assistance? If so, for how long?
- Do I need a referral from my transplant team to be eligible?
- How long does it take to apply and process paperwork to get started with your program?
- How do I receive the drugs?
Many insurance policies state a total amount of money that will pay out in your lifetime, also referred to as a "cap." After the insurance company pays this amount, they are not required to pay additional benefits. Some policies also put a cap on how much they will pay for a particular procedure or treatment, such as a transplant or the total amount of drugs per year. Even after the actual transplant, the ongoing cost of care may exceed the cap. Because the amount of the cap varies greatly depending on the individual policy, it is important to be familiar with the terms of your insurance cap and keep track of how your insurance dollars are spent.

Alternatively, you can call your state insurance commissioner to see if the following plans are available in your state:
- Certain people with pre-existing conditions, who have been denied insurance coverage, qualify for high-risk pools. High-risk pools are only offered in some states and premiums can be from 50% - 200% higher than standard policies. Benefits are usually more limited than standard policies and have limited coverage for outpatient medication.
- Some states offer guarantee issue, which requires insurers to offer individual coverage regardless of pre-existing conditions. All individual policies are usually more costly in these states.
- Federal fallback requires insurance companies to offer coverage to patients whose existing COBRA benefits are ending. It is only available in some states and provides patients a choice of the two most popular insurance plans that the insurance company offers. The premium is the same as everyone else within the policy.
Charitable organizations may be able to help in a variety of ways. Some may offer educational information about disease management and subsequent options. Some may provide financial assistance. Often these funds are for smaller amounts of money and usually limited to the direct costs associated with the transplant.

Some people are able to raise money for their transplant with a fundraiser. Keep in mind that funds raised this way are subject to certain rules and may conflict with some of your other income sources. Discuss this option thoroughly with your Financial Coordinator before you proceed.

The United Network for Organ Sharing (UNOS) has put together a list of many organizations that can provide financial assistance to transplant recipients. Visit www.unos.org and click on "Patient Resources" or call 1-888-894-6361.

The Social Worker and the Financial Coordinator on the Kidney Transplant Team will have information on many charitable assistance programs. These professionals can help answer many of your questions; but it is always recommended that you explore the details and limitations of available assistance directly with the charitable organizations.

Patient and Family Services

From the West Via PA Turnpike, Schuylkill Expressway and I-476:

Take the Pennsylvania Turnpike to Exit 326 (Philadelphia/Valley Forge) then follow I-76 (Schuylkill Expressway) approximately 5 miles to Route I-476 South (The Blue Route). Take I-476 South for approximately 15 miles to the MacDade Boulevard exit. Follow the exit ramp, keep right at the fork and merge onto MacDade Boulevard. Continue onto East 22nd Street and keep right at the fork. Make a sharp left-hand turn onto Upland Avenue; then take the first right onto Seminary Avenue. Crozer Health is just ahead.

From Northeastern Pennsylvania Via Pa Turnpike:

Take the Pennsylvania Turnpike (Northeast Extension – I-476 – partial toll road) South to the MacDade Boulevard exit. Follow the exit ramp, keep right at the fork and merge onto MacDade Boulevard. Continue onto East 22nd Street and keep right at the fork. Make a sharp left-hand turn onto Upland Avenue; then take the first right onto Seminary Avenue. Crozer Health is just ahead.

From New Jersey and North Via I-95 (New Jersey Turnpike):

Take I-95 South to Exit 7A (I-195 West). Keep left at the fork and merge onto I-195 West. Continue onto NJ-29 North, travel approximately 4 miles and take the ramp onto US-1 South. Follow US-1 South for approximately 7 miles and take the exit onto I-95 South (Central Philadelphia). Travel approximately 40 miles and take Exit 6 for PA-320. Turn left onto PA-320 South (Chestnut Street). Take the first right onto East 12th Street. Turn right onto Edgemont Avenue, then take the second left onto East 14th Street. Continue onto Upland Avenue and turn left onto Seminary Avenue. Crozer Health is just ahead.

From Delaware, Maryland and the South Via I-95:

Take I-95 North to Exit 5 (toward Kerlin Street). Merge onto West 12th Street. Turn left onto Kerlin Street, then a slight right onto Upland Avenue. Turn right onto Seminary Avenue. Crozer Health is just ahead.

From Atlantic City and the South Jersey Beaches:

Take the Atlantic City Expressway West toward Philadelphia. Continue onto NJ-42 North. Travel approximately 7 miles and merge onto I-76 West. Make a slight left to stay on I-76 West and travel approximately 3 miles to Exit 351 for I-95 (Trenton-Chester). Keep right at the fork and follow signs for I-95 South. Merge onto I-95 South. Travel approximately 13 miles and take Exit 6 for PA-320. Turn left onto PA-320 South (Chestnut Street). Take the first right onto East 12th Street. Turn right onto Edgemont Avenue, then take the second left onto East 14th Street. Continue onto Upland Avenue and turn left onto Seminary Avenue. Crozer Health is just ahead.

From Cherry Hill, NJ Area:

Take Marlton Pike West and merge onto U.S. Route 30 West (toward the Benjamin Franklin Bridge). Travel approximately 4 miles, cross the Benjamin Franklin Bridge and follow the signs for I-95 South (Chester/Philadelphia International Airport). Keep right at the fork and merge onto I-95 South. Travel approximately 16 miles and take Exit 6 for PA-320. Turn left onto PA-320 South (Chestnut Street). Take the first right onto East 12th Street. Turn right onto Edgemont Avenue, then take the second left onto East 14th Street. Continue onto Upland Avenue and turn left onto Seminary Avenue. Crozer Health is just ahead.
Crozer Health offers many safe and convenient parking options:
- Valet Parking is available directly outside of the main hospital entrance off Seminary Avenue. Open Monday through Saturday from 6:00 a.m. to 9:00 p.m.
- Self-Parking is available 24-hours a day, seven-days a week at two secure garage locations directly adjacent to the hospital.
Crozer Health ’s Security Department provides protection and a safe environment for patients, visitors and employees. Security officers patrol the hospital and the surrounding, well-lit campus. Officers are available to escort visitors to their cars when leaving the facility and to assist with minor automobile problems. Hospital Security can be reached by dialing 610-447-2888.
Have a small bag packed (or at least, a list of what you need to pack) with toiletries, a pillow, comfortable clothes, spare glasses, books or crossword puzzles. You will not need anything until you come out of the Intensive Care Unit at the conclusion of your surgery, at which time your family can bring your personal items. Make sure that your family knows where your packed bag is so that they can bring it when it’s time.

Beyond your personal items, there are a number of other things that you’ll need to have:
- Insurance Information: You must bring all insurance information, forms and cards as proof of current insurance coverage, and if required, you must obtain a pre-certification or referral prior to admission.
- Medication List: A list of all medications that you are taking (but do NOT bring medications from home)
- Power of Attorney or Guardianship: Designate a power of attorney or guardianship if your next of kin is not capable of this responsibility. This designation must consist of a comprehensive plan and be notarized. Our Social Worker will guide you through this process. The designee must be someone you can trust to follow your wishes and act in your best interest in the event that you are not capable. The designee does not have to be your next of kin. Your designee's name must be included on all your bank accounts, safety deposit boxes, and other financial and personal records.
- What Not to Bring: Do not bring televisions, laptop computers, large radios, computer games or electrical appliances. Do not bring money, credit cards, jewelry, flowers/plants, pets, fresh fruit or vegetables, large suitcases, clothes or children less than 14 years of age. Also, be sure to ask your family to take your possessions and valuables home. Crozer Health cannot be responsible for valuables unless they are locked in the hospital safe.
The Gift Shop is located on the first floor in the main lobby. Books, magazines, newspapers, candy, cards, flowers, gifts, personal items and more are for sale. Upon request, items can be delivered to patient rooms.

Hours
- Monday-Friday, 10 a.m. to 8 p.m.;
- Saturday and Sunday, noon to 8 p.m.
There are a number of food service options in the hospital.
- The Atrium: Breakfast, lunch and dinner. Located on the first floor, near the main lobby. Hours: Monday-Friday, 7:30 a.m. to 7:30 p.m.; Saturday and Sunday, 7:30 a.m. to 6:30 p.m.
- The Cafeteria: Breakfast and lunch. Located on the ground floor. Hours: Monday-Friday, 7 a.m. to 2 p.m.
- Vending machines: Offering drinks and snacks. Located on the ground level of the medical center near the Cafeteria and near the Emergency Department, as well as on the fourth floor near the waiting area.
Cell phones may be used in the main lobby, Atrium and Cafeteria only. Pay phones are located:
- 1st floor, near 1 West
- 2nd floor, near the entrance of EEG/EMG
- 4th floor, at the entrance to the West Wing
To maintain a healthy environment for our patients, visitors, employees and physicians, Crozer-Chester Medical Center does not allow tobacco use of any kind on its grounds. This includes personal vehicles on the property. For more information about the policy or about smoking cessation programs, visit http://smokefree.crozerkeystone.org.

Questions Asked by Transplant Families

Your loved one’s breathing tube will be removed as soon as he or she is able to breathe on his/her own. In the meantime, talk with your loved one. Sometimes he/she may seem to be sleeping but can still hear you. If your loved one is awake, you can give him/her a pen and paper to write notes to you.
Conversational and medical interpretation services are available for our non-English speaking patients and their families. If you would prefer that your healthcare be provided in a language other than English, please ask your Transplant Coordinator to arrange for an interpreter for you.

We also offer services for hearing or sensory impaired patients. Available services include:
- Credentialed sign language interpreters
- Over-video sign language interpreters
- TDD teletypewriters
- Special nurse call buttons
- Closed caption televisions