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Date issued: February 2022

Review date: February 2024 

Ref: A-425 V2

Ref:  Assessment for transplantation and waiting list final February 2022 v2.pdf [pdf] 217KB

About the Transplant Assessment Clinic

The transplant assessment clinics are usually run in the afternoon of the second and fourth Wednesday of each month, at Derriford Hospital. We encourage you to attend a face-to-face education appointment prior to being seen in transplant assessment clinic. This is an opportunity to find out more about the advantages and disadvantages of transplantation and ask any questions. Education clinics are led by one of our transplant nurse practitioners. If you have not received this education and wish to do so before the assessment clinic then please contact us.

During the consultation in the transplant assessment clinic, the doctors will review your medical history. They will usually ask to examine your abdomen, assess your pulses to check your blood flow in your legs, and listen to your heart and lungs.

The doctors will also review the results of any relevant medical investigations which may have been organised at your local hospital. These tests often include cardiac (heart) tests such as ECGs (electrocardiograms), echocardiograms (an ultrasound scan of the heart), cardiac MRIs or myocardial perfusion scans (stress tests). This is to try to ensure that you are fit enough for the transplantation surgery. For a similar reason, patients may be asked to do a Cardiopulmonary Exercise Test (CPET) at some point before or after the transplant assessment clinic. This is a fitness assessment on an exercise bike which assesses how well your heart and lungs work together.

Some patients will also need a doppler ultrasound test to see how good the blood flow through the arteries and veins supplying your legs are. This is usually required if you have diabetes or if your pulses are hard to feel.

The doctors in the transplant assessment clinic will discuss your suitability for transplantation with you directly. They may also discuss with you any possible concerns they have about you being transplanted, such as specific medical conditions, the likelihood of surgical problems or recurrence of your original kidney problem.

Sometimes the doctors in the transplant assessment clinic may decide that further tests are required to assess your suitability for transplantation. They may ask your local kidney team to organise these.

The doctors will also discuss the possibility of living kidney donation with you and consider the different types of deceased donor kidney transplantation. If you have a potential living kidney donor then you are more than welcome to discuss this with the living donor coordinators so that they are able to get in touch with them.

Blood tests are also taken during this appointment. The blood tests required usually include “tissue typing tests” (tests to ensure that organs can be correctly matched to you in the future). Tests to screen for infections (including HIV, hepatitis, EBV and CMV) are also usually performed in view of the need to dampen down a patient’s immune system to prevent transplant rejection.

It is not always possible for the doctor in the transplant assessment clinic to say for certain, during your consultation, whether you are definitely suitable for transplantation. This is because they will want to see the results of blood tests and of any additional tests they have recommend. They may also want to talk to your own kidney doctor. For this reason, your case is then discussed at the weekly transplant multidisciplinary meeting where the final decision is made. This usually happens the week after the transplant assessment clinic appointment but can take longer if additional information is required. The transplant nurse will then discuss the outcome of the meeting with you. If you are accepted for transplantation, the transplant nurse will be in contact with you to ask if you want to be activated onto the deceased waiting list. If you have a potential live donor, you can be activated on the waiting list then suspended 2 weeks before the planned date of your live donor transplant.

The Transplant Waiting List

Patients who are active on the transplant waiting list are those who have been assessed in the transplant assessment clinic and have been considered fit enough to receive a transplant. You can be on the deceased donor transplant waiting list whilst waiting for any potential live donors undergo testing.

Allocation of kidneys to patients on the Transplant Waiting List

Unfortunately, the number of organs available for transplantation is lower than the number of people on the transplant waiting list. This is a national problem and the organs that do become available are all very different. This is because all donors are different, the donors may be young or old, may have different medical problems, and will of course have different blood groups and genetics. The patients on the transplant waiting list are all also, very different and their individual needs vary too. Therefore, not every kidney that becomes available is suitable for every patient on the list.

The allocation of kidneys offered for donation is coordinated by a national organisation called NHS Blood and Transplant (NHSBT). This organisation keeps a secure database of all the patients in the UK who are waiting for organ transplants. This information includes their name, address and their tissue type. When a kidney becomes available an algorithm is used by NHSBT to identify potential recipients. The algorithm takes into account the blood group of the donor, the age and genetic match with possible recipient.

This information is given to the Transplant Centre’s on-call kidney doctor and surgeon at Derriford Hospital, to decide if this kidney is suitable for the patient to whom it has been allocated. The team will also call their local kidney team if they need further information to help make this decision. The aim is to accept the best kidney for you which will help to give you a good quality of life.

Once we have accepted the kidney offer for you, one of our transplant nurses will call you and ask for you to come to Derriford Hospital. More information about this is provided below.

The average amount of time that a patient waits on the deceased donor transplant waiting list varies between the different UK transplant centres. Over recent years Plymouth has had one of the shortest average waiting times with an average waiting time of 2 years. For some patients the wait, for various reasons, might be much longer than the average.

When you are active on the transplant waiting list, we require you to have a blood test every six weeks to check the antibodies (LCA) in your blood. This is so that we can reduce the risk of rejection when you receive a transplanted kidney.

How will I get the best kidney for me?

Finding the right kidney is rather like finding the right partner in life; the more people you have to choose from, the more likely you are to find someone with the right match. This is where NHSBT comes in. They act like a matching agency and keep a secure database of all people in the UK who are waiting for organ transplants. This includes names, addresses and, most importantly, their tissue types. Whenever a kidney donor becomes available anywhere in the country, NHSBT are informed and they work around the clock to ensure that the donor’s organs are placed with the most suitable recipients. Once you have been assessed and given permission to be listed for a kidney transplant, your name and details will be added to this database.

Then begins the wait which could be weeks; it could be years; but always remember, the system is designed to find you the best kidney. In Plymouth our average waiting time is 2 years.

Advice for patients on the Transplant Waiting List

Kidneys from deceased donors are allocated by a central organisation NHS Blood and Transplantation (NHSBT). The offer can come through at any time of the day or night. When you are active on the transplant waiting list, it is important that you are contactable at all times and you must keep the transplant centre updated with changes to your contact details.

Once you are active, we encourage you to keep a bag packed ready for a hospital stay. It is sensible that you bring any medications that you are taking, pyjamas, a wash bag, slippers and a small amount of money.

We ask that you discuss the likelihood of being called in at short notice with your relatives and carers and to have arrangements in place for dependents and pets. In addition to this, we ask that you have a plan in place for travel arrangements for when you are called in. It is sensible for patients on the transplant waiting list to discuss their situation with their employers as you will be called up with minimal notice and will be off work several weeks.

It is important to consider your general health and fitness whilst you are waiting for a kidney, as including physical activity into your daily routine now will help your post-op recovery. Guidelines suggest adults should have 150 minutes of activity a week, this is about 20 minutes a day. Activity is not necessarily formal exercise such as going to the gym and it can be as simple as walking each day, using the stairs instead of the lift, swimming, dancing to improve balance or even yoga and carrying heavy shopping bags to strengthen muscles. If you spend long periods sat down, try to break up this time with regular movement such as a short walk, a few simple on-the-spot exercises or stretches. Physically active people can reduce their risk of high blood pressure and type 2 diabetes by over 30%.

Consenting to transplantation

Transplantation offers the opportunity to avoid dialysis and live a longer life. However, there are risks involved. These are mainly due to the surgery and the drugs that are required to prevent rejection. The risks vary from patient to patient. It is important that you understand these risks. Information will be provided to you in both the transplant assessment clinic and at the education clinic.

When the day arrives

• You will get a telephone call from the transplant coordinator based at University Hospitals Plymouth to say that they have a potential kidney. If the allocated kidney is      for a patient in either Exeter or Cornwall the transplant coordinator will also talk to the nephrologist on call at that specific centre to make sure they are also happy with the offer.
• The transplant coordinator will ask you to make your way to Mayflower Ward as soon as possible. The coordinator on call will guide you through the process and answer any questions they might have. Once you arrive on Mayflower ward, you will be introduced to the nurse who will be looking after you. A laboratory test (cross-match) is needed to check that the donor kidney is compatible with your antibodies. It takes roughly three to four hours for a complete report. However, if we have received regular antibody bloods whilst you have been active on the waiting list, then this information is already available to us and we can perform a virtual cross match which     eliminates the waiting time prior to the operation. If the cross match shows that the organ is not suitable, it may be necessary to cancel the operation. This is a very rare occurrence and is more likely if you have had a previous transplant or have high antibody levels.
• A transplant surgeon will go through the procedure of the operation and explain once more about what to expect and the risks of complications. When you fully understand we will ask you to sign a consent form for the operation. We do encourage you to ask any questions you might have at this point.
• The transplanting surgeon will also assess the kidney prior to surgery. Occasionally, it may be necessary not to proceed with the operation if there is anything of concern  with the organ itself. Please remember the offer of a kidney is deemed potential, and until you are taken to theatre there may be a reason, albeit very rarely, that the operation cannot proceed. This will be discussed with you at the time should there be any concerns.
• You will also be seen by an anaesthetist who will examine you and tell you about having a general anaesthetic.
• When the theatres are ready, the porters will come and collect you and take you to theatre. Patients often feel nervous, which is completely normal. In the operating             theatre reception, a theatre practitioner will go through a checklist and ask a few questions.
• You will then go to the anaesthetic room, where the anaesthetist and his/her assistants  will explain what they are going to do. They will put a small needle into the     back of your hand and the anaesthetist will inject a drug that will send you to sleep.

We look forward to seeing you in the transplant assessment clinic.