Hahnemann has maintained a kidney transplant program since performing one of Philadelphia's first kidney transplants in the mid-1960s. This program now includes pancreas transplants as well as kidneys.
The unit consists of an eight-bed unit, staffed by specially trained nurses, who maintain and support current scientific protocols in delivering care to transplant patients. Two full-time certified nurse coordinators work exclusively with these patients, along with a team of specialized surgeons and medical support staff, to follow patients before, during and well after the procedure.
Hahnemann is one of the few sites that transplants pediatric organs to adult recipients. In addition to the inpatient area, the program has an outpatient suite where patients come for biopsy, antibiotic infusions and other treatments.
A Guide to Kidney & Pancreas Transplantation
Who is a candidate for a kidney transplant?
Candidates for kidney transplantation are individuals with severe kidney failure. This includes patients well before dialysis and those who are about to begin dialysis or who have already started dialysis treatment.
For patients with Type 1 or Juvenile Type Diabetes who have kidney disease, a combined kidney and pancreas transplant may be the best alternative to dialysis and insulin therapy. A combined organ transplant provides for independence from daily insulin injections and may prevent further complications due to diabetes.
Are there advantages to transplantation?
A successful kidney transplant offers patients with kidney disease a return to a normal lifestyle. Transplant patients lead a full life with freedom from dialysis treatment, diet and fluid restrictions, travel limitations and frequent medical care. The current success rate for kidney transplantation is approximately 90 percent at one year and is even higher with kidneys donated by family members.
What are the patient responsibilities for maintaining a kidney transplant?
Individuals with kidney disease are referred to a transplant center by their nephrologist or dialysis nurse. Patients first undergo a thorough medical and surgical evaluation after which time they are considered for transplantation. Following transplantation, patients need to follow a strict treatment plan consisting of daily immunosuppressive drugs that prevent rejection. The need for these medications is absolute and persists for the life of the transplant.
Patients are monitored very closely at Hahnemann University Hospital for the first three months. Afterwards, patients return to the care of their primary nephrologist and family physician, returning to Hahnemann to monitor their anti-rejection therapy every three to six months.
What is the evaluation process?
An initial visit to the transplant center consists of meeting with the transplant surgeon, nephrologist, coordinators, social workers and financial consultants. Patients undergo an extensive medical evaluation. Many of the required medical tests may be performed locally in collaboration with the patient's primary physician.
Good health rather than age is the important factor in determining a patient's suitability for transplantation.
Are there complications to transplantation?
The incentives of transplantation include undergoing a surgical procedure to have the new organs placed in the body. In addition, patients must take immunosuppressive drugs that block the immune system responsible for rejection. These agents increase the risk of infections, may worsen hypertension, may elevate blood cholesterol levels and may increase the risk of certain tumors. Despite these potential problems, given proper medical supervision by an experienced team, patients live longer and have an improved quality of life following transplantation. Newer and safer drugs are constantly being developed. At Hahnemann, the newest agents are routinely used to improve the success of transplantation and minimize the side effects associated with transplantation.Where do kidneys for transplantation come from?
There are three important sources of kidneys:
This is the most common type of transplant that is performed using organs from individuals who donate at the time of their death. Kidneys are obtained by the "Gift of Life" Organ Procurement Organization Program that serves Hahnemann University Hospital. Kidneys are allocated according to the time waiting for transplant and blood type. The distribution of donor kidneys is very equitable and is guided by Federal policy standards that ensures equal access to needed organs for all patients. The "Gift of Life Program" is very active, allowing for transplantation in the shortest possible time. Because of the increased number of patients with kidney disease who need donor kidneys, the average time to receive a transplant is now approximately three years.
Living Related Donors (LRD)
Any family member, no matter how distant the genetic relationship, can donate a kidney. There are many advantages to a living familial donor kidney. First, the patient does not have to wait for a kidney. Secondly, living donor kidneys function immediately, allowing for early discharge from the hospital. In general, LRD kidneys last longer and function better than cadaveric kidneys. Finally, given a good genetic match, the recipient may need less immunosuppressive therapy.
Living Unrelated Donors (LUD)
A wife or husband or an emotionally attached individual, for example, a good friend, can donate a kidney. These kidneys also are very successful and function almost as well as a kidney from a relative.
All potential living donors first undergo an extensive medical evaluation to ensure that they are in good health and suitable donors. Healthy individuals who donate a kidney appear to have no detrimental effects on their long-term health. Moreover, laparoscopic surgery has made donation less invasive allowing for rapid recovery and return to normal activities.
How does the donor-recipient matching process work?
Blood type determines the compatibility for kidney transplants. Kidney donors and recipients with compatible blood types are further tested for "tissue-type" compatibility with a test known as CROSS-MATCH. In this test, the recipient's serum is mixed with the donor's blood cells. If the recipient serum does not kill the donor cells, the test is said to be "compatible" and the transplant can be performed. A recipient may have to be tested with many potential donors before a match is found and some "tissue-type matches" may be better than others. Age, sex, or race of the donor and recipient are not determining factors in successful cross matching.
Once the kidneys are removed from the donor, the can be preserved for 24 to 48 hours. When a recipient is selected, the organ is shipped to the recipient's transplant center.What happens during transplant surgery?
Under general anesthesia, an incision is made in the lower abdomen. The kidney is placed on the left or right side and attached directly to the bladder. The native kidneys are not removed. The operation usually takes from two to four hours.
What should a recipient expect following surgery?
The patient is usually out of bed and walking a day or two after surgery and is eating a normal diet with three days. Drugs to control rejection start immediately. During the hospital stay, the patients are taught about the anti-rejection medications and become knowledgeable about the warning signs of rejection.
Organ recipients must return for appointments twice a week for the first one to two months following surgery and less frequently after that. During the visits, blood tests are performed to detect early signs of rejection and any side effects from medication are addressed.
Who needs a pancreas transplant and why?
For those individuals with diabetes, a pancreas transplant can help end their dependence on insulin injections, greatly improve their quality of life and avoid further progression of complications from the disease. In many cases, a kidney/pancreas transplant is performed because the patient may already be in kidney failure.
The current expected success rate of a combined kidney/pancreas transplant is 80 to 85 percent at one year.What is the cost of a transplant?
The average cost of a transplant is between $50,000 to $80,000 depending on each individual case and the number of organs transplanted, possible complications and the length of stay.
Medicare has been the primary source of payments for kidney transplants. Effective July 1, 1999, pancreas transplants are covered by Medicare as well. However, Medicare may not be cover some costs. The transplant financial coordinator can find out what is not covered by Medicare and discuss with you the payment arrangements for those charges.Who pays for the transplant?
Source of payment for additional costs may include:
For Information or Appointment:Call the Division of Transplantation at Hahnemann University Hospital at (215) 762-1857.
History of our Transplant Program
Hahnemann University is one of the leading institutions in the Delaware Valley for kidney and pancreas transplantation. In 1963, Hahnemann became the first hospital in the Delaware Valley to perform kidney transplants. The current team continues this time-honored tradition of providing excellent patient care. Each year, approximately 80 kidney transplants are performed at Hahnemann for patients located throughout Pennsylvania, New Jersey and Delaware. According to the 1998 national statistical data reported by the United Network for Organ Sharing (UNOS), Hahnemann achieves superior three-year transplant survival.
Advantages of the Hahnemann University Hospital Transplant Program:
The Hahnemann program provides a fully integrated approach to patient care that includes physicians, nurse coordinators, social workers, and financial assistants.
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