During a kidney transplant evaluation, a transplant coordinator will arrange a series of tests to assess your treatment options. You'll be evaluated for potential medical problems such as heart disease, infections, bladder dysfunction, ulcer disease and obesity. A social worker will discuss transportation, housing, financial and family support needs in regard to a transplant and a financial counselor will address the benefits of your insurance policy.
We want you to learn as much as possible about the transplant process before making a decision.
Screening Tests
Regardless of the type of kidney transplant you may undergo — living or cadaveric — special blood tests are needed to determine your blood and tissue type. These test results help match a donor kidney.
Blood Type
The first test establishes blood type. There are four blood types — A, B, AB and 0. Everyone fits into one of these inherited groups. The recipient and donor must have either the same blood type or compatible ones. The list below shows compatible types.
- If your blood type is A, donor blood type must be A or O
- If your blood type is B, donor blood type must be B or O
- If your blood type is AB (universal recipient), donor blood type must be A, B, AB or O
- If your blood type is O (universal donor), donor blood type must be O
The AB blood type, called the universal recipient, is the easiest to match because the individual accepts all blood types. Blood type 0, called the universal donor, is the hardest to match. Although people with blood type O can donate to all types, they can only receive kidneys from blood type 0 donors. For example, if a patient with blood type O were transplanted with a kidney from an A donor, the body would recognize the donor kidney as foreign and destroy it. The Rh type (+, -) is not a factor in donor matching.
Human Leukocyte Antigens (HLA)
The second test, a blood test for human leukocyte antigens (HLA), is called tissue typing. These antigens are substances found on many cells of the body, but are mostly seen on white blood cells. Tissue type likeness between family members may be 100, 50 or 0 percent. The tissue type of all potential donors is considered in donor selection.
The prospective recipient and all interested family members and non-relatives can arrange with the transplant team to have the tissue typing test. No special preparation is required and results are available within two weeks. Pre-packaged kits with instructions to collect and return blood samples are available for mailing to out-of-town relatives. Blood can be drawn at a local doctor's office or hospital laboratory and sent to the UCSF Transplant Service via ovennight mail.
Crossmatch
Your body makes substances called antibodies, which are produced by the immune system to attack foreign substances, such as bacteria and viruses. You make antibodies when you have an infection, are pregnant, have a blood transfusion or undergo a kidney transplant. If you have antibodies to the donor kidney, your body will destroy the kidney. To ensure that you don't already have antibodies to the donor, we conduct a test called a crossmatch. The crossmatch is done by mixing your blood with cells from your donor. If the crossmatch is positive, you have antibodies against the donor and should not receive this kidney. If the crossmatch is negative, you don't have antibodies to the donor and you're eligible to receive this kidney.
Crossmatches are obtained several times during preparation for a living-related donor transplant, particularly if donor-specific blood transfusions are used. A final crossmatch is performed within 48 hours before the transplant.
Serology
Testing is conducted for potentially transmissible diseases, such as HIV (human immunodeficiency virus), hepatitis and CMV (cytomegalovirus).
Transplant Waiting List
When the transplant evaluation is complete, the transplant team will meet and discuss your results. Your medical and social history is evaluated and a decision is made whether to place you on the transplant waiting list. This decision is made only after discussing your situation with a nephrologist or kidney specialist, surgeon, transplant coordinator, social worker and financial counselor.
If a transplant is not in your best interest, a transplant team member will discuss other options with you. You may qualify for a kidney transplant if:
- You have end-stage renal disease
- You are a child with end-stage renal disease and severe growth retardation
People who are 60 years of age and older are considered for transplant on an individual basis after medical and cardiovascular evaluation. People with anatomically abnormal urinary tracts may not qualify until appropriate reconstructive surgery is completed. You may not qualify for a kidney transplant if you:
- Recently had cancer
- Recently had a heart attack
- Recently abused drug or alcohol
- Have an active infection