Starting the Transplant ProcessYour road to an organ transplant starts with the physician or specialist who is providing your care. If he or she determines that you are in organ failure or may soon be in organ failure, you will be referred to a transplant center. The transplant center may not be the closest center to you, as the organs transplanted at each center vary.
Once you have a referral, you will need to make an appointment for an evaluation. The initial appointment will probably include a physical examination and blood draws for a wide variety of lab studies. These blood tests will help determine how well your organs are functioning and your general state of health.
Once your organ function is determined, your transplant surgeon will be able to determine if testing to determine your suitability for an organ transplant should continue. At this point you may be told that you are currently too well for consideration, not a candidate or that testing will continue.
Additional Medical Testing Required for TransplantIf you are a candidate for an organ transplant, you will undergo further testing. If your organ failure happened quickly, is progressing quickly or is considered an emergency, the testing may occur in a matter of days rather than weeks.
Your testing will also evaluate your ability to tolerate surgery. For example, if you are seeking a liver transplant, you may still be tested for heart, kidney and lung function to make sure you are able to tolerate surgery and anesthesia.
You will be evaluated for the presence of cancer, as an active case is cause for exclusion from transplantation. There are exceptions, such as skin cancer, which would not prevent you from receiving a new organ.
If you are in need of a kidney transplant, your testing will include blood tests that look at your genetic makeup since it is a component of matching organs with recipients.
Psychological Evaluation Before TransplantationYour evaluation as a potential transplant patient will include appointments with social workers, psychologists and financial counselors. You will also be evaluated for your ability to understand instructions and your treatment.
Patients who have untreated psychiatric or mental disorders may be disqualified for treatment if the disorder prevents the patient from caring for themselves. For example, a schizophrenic patient who is not taking medication and is having delusions would not be considered a good candidate for an organ transplant. Mental retardation is not an automatic exclusion from receiving a transplant.
The stress of waiting for a transplant can be difficult for families, and the social workers and psychologists will work to evaluate how well you and your loved ones will cope with the wait. It is essential that you are candid as part of the evaluation includes determining how best to provide you with the support you need.
Financial Counseling for TransplantationThe financial counselor will help determine if you can afford to pay for a transplant, as well as your ability to pay for the numerous and expensive medications that help keep your body from rejecting the organ after surgery.
Not being able to afford a transplant does not mean that you will not be considered for surgery. The social workers and financial specialists will help determine if you are eligible for Medicare, Medicaid or other assistance.
Evaluation of Addictive and Harmful BehaviorsIf your disease is the result of addictive or abusive behaviors, such as cirrhosis caused by alcoholism, you will be expected to be free of such behaviors. Transplant centers vary on their policies regarding the length of time a patient must be drug-free to qualify for a transplant, but most will test for drugs regularly.
Social workers will help you seek counseling and support groups for your addictions, if needed. An inability to control addictive behaviors will exclude patients from being listed for a transplant.
Your Ability to Manage Your Health Before TransplantThe transplant center will be looking for indications that you are able to manage your health and that you care about maintaining your health whenever possible. For example, if you are waiting for a kidney transplant but you are not following your doctor’s instructions, you may not be considered a candidate. The post-transplant regime is rigorous and requires diligence; your ability to follow your current regimen will be considered an indication of your willingness to take care of yourself after surgery. Non-compliance with important health maintenance instructions, such as drinking alcohol while in treatment for a liver problem, could exclude an individual from the liver transplant list.
The Decision -- National Waiting List or Not?You will be notified if you have been approved for transplantation once the evaluation has been completed and the different members of the team have made a determination of your suitability. The decision is not made by any one person; the team as a whole decides if you will make a good candidate for a successful transplant.
If you are approved, you will be expected to maintain an ongoing schedule of appointments designed to keep you in the best possible health during your wait, and to monitor your organ function. For some organs, the level of organ function (or the extent of your organ failure) helps determine your place on the wait list, so recent lab results are essential.
Being listed for a transplant is a very exciting time, but it is essential to remember that most transplant recipients have an extended wait before their surgery. It is not uncommon to wait several years for a kidney transplant, for example.
If the transplant center declines to add you to the list of patients waiting for transplant, you have some options. At some centers, you can appeal the decision and attempt to have the team reconsider its decision. You can also be evaluated at a different transplant center that may have different criteria for selecting patients.
More Information: Coping After an Organ Transplant
Getting on the List-The National Waiting List. Transplant Living. 2008. http://www.transplantliving.org/beforethetransplant/list/waitList.aspx
Interview. Elizabeth Davies, M.D., Faculty, The Ohio State University. 2008.
Transplant Process. University of Michigan. 2008 https://www.med.umich.edu/trans/public/lung/process.htm