kindney tranplant

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QUESTIONS PATIENTS MIGHT ASK ABOUT KIDNEY

TRANSPLANT

1. How much will a transplant cost? Will my insurance pay for my transplant?What will my medications cost?

It is impossible to provide a complete list of transplant costs for each Network 5 transplant center. Patients

need to be aware that transplant centers have financial counselors available to discuss and explore

transplant costs so the patient knows exactly what costs are covered. The counselor will also ask the

patient to provide complete financial information, which will be kept confidential.

It has been estimated that first year cost of a kidney transplant is $116,100. Medicare covers all reasonable

expenses with the exception of the Part A deductible and the Part B 20% co-insurance. Patients are

encouraged to have a primary and secondary insurance policy in place before initiating transplant work-up

(dialysis facility social workers may be able to assist patients in obtaining secondary or Medigap hospital

insurance policies). Remember that you must think about the 20% cost of surgery andimmunosuppressive

medications if you elect to have only Medicare coverage, and those costs add up quickly. If the patient has

a private primary insurance carrier, transplant benefits should be verified prior to evaluation, including

information on deductibles and co-payment requirements. The transplant center financial counselor orsocial worker will assist the patient in obtaining this information. Patients are encouraged to ask about

pre-approval for transplant and approved transplant centers. The patient should be certain that

each monthly insurance premium is paid so that there is no lapse in insurance coverage.

It is necessary for every transplant recipient to take several different medicines to keep you body from

rejecting or damaging the new kidney. Currently, Medicare covers immunosuppressive medications for

three years after kidney transplant for End Stage Renal Disease Patients (ESRD) patients. Congress has

extended this coverage for the life of the transplanted kidney if the patient is eligible for Medicare due to

age, or receives Social Security Disability Income (SSDI). The annual cost of immunosuppressive

medications is estimated to be approximately $20,000. Some pharmaceutical grant programs exist for a

small number of indigent patients. The transplant center may be able to help patients explore these options.

These immunosuppressive medications also change the way your body responds to infection. Please be

certain that you ask questions about these medications and their use when you see the transplant center

staff.

2. Will receiving a transplant make my life better?Transplant patients state that receiving a new kidney allows them to return to a more normal life, feel

better, and be more active. They enjoy freedom from dialysis, and have fewer dietary restrictions.

Statistically, patients who receive kidney transplants have a longer life expectancy than dialysis patients.

The following tables display United States Renal Data System (USRDS) survival probability rates from the2001 Annual Data Report (Reference Tables 1.22 and G.3). More USRDS data can be viewed on the

Internet at http://www.usrds.org/reference.htm. Survival data are displayed for patients who received

cadaveric transplants, living donor transplants, and new (incident) dialysis patients during the periods

shown below. Age comparisons were aligned as closely as possible, based on USRDS selected age

cohorts.

1 year cohort, 1998, 5 year cohort data, 1994, and 10 year cohort data, 1989.

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USRDS PATIENT Survival

Unadjusted Probability Rates

USRDS GRAFT Survival


Following 1st Cadaveric Transplant Following 1st Cadaveric Transplant

Patient Age 1 Yr 5 Yr 10 Yr Patient Age 1 Yr 5 Yr 10 Yr

18-29 Yrs Old 98.2% 91.6% 76.4% 18-29 Yrs Old 90.8% 53.7% 38.0%

30-44 Yrs Old 97.1% 85.0% 64.5% 30-44 Yrs Old 91.7% 61.4% 37.5%

45-54 Yrs Old 94.9% 79.9% 52.3% 45-54 Yrs Old 88.4% 59.2% 34.2%

USRDS PATIENT Survival


USRDS GRAFT Survival


Following 1st Living Donor Transplant Following 1st Living Donor Transplant

Patient Age 1 Yr 5 Yr 10 Yr Patient Age 1 Yr 5 Yr 10 Yr

18-29 Yrs Old 99.7% 95.8% 86.5% 18-29 Yrs Old 94.7% 53.7% 70.5%

30-44 Yrs Old 98.8% 91.2% 78.7% 30-44 Yrs Old 95.1% 61.4% 74.5%

45-54 Yrs Old 97.4% 86.5% 65.5% 45-54 Yrs Old 94.1% 59.2% 70.8%

USRDS Patient SurvivalUnadjusted Probability Rates

Incident (NEW) Dialysis Patients

Patient Age 1 Yr 5 Yr 10 Yr

20-29 Yrs Old 94.8% 73.0% 41.1%

30-39 Yrs Old 90.9% 58.7% 30.9%

40-49 Yrs Old 88.9% 51.0% 19.2%

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Can I catch a serious disease like AIDS if I get a kidney transplant?

The transplant center and Organ Procurement Organization (OPO) will conduct multiple tests to

prevent disease transmission from the donor during transplantation. All donors, both cadaveric and

living, are tested for infectious diseases including HIV, Hepatitis B and C, and Cytomegalovirus

(CMV). Additional tests are conducted to determine the status of other diseases, which could present a

problem for the immunosuppressed patient after transplant.

How can I be sure I will get the right kidney for me?

Laboratory tests will be done to insure that the donor and recipient are medically compatible. These

include blood type (A, B, O grouping), genetic testing of body cells for HLA typing (Human Leukocyte

Antigen), and monthly Panel Reactive Antibody (PRA). The recipients blood is tested each month to help

the physician evaluate any changes until a transplant occurs. The patient should be certain that the dialysisunit or physicians office draws these monthly blood samples, and sends them to the transplant center.

When an organ is available, it is offered to patients who are the best match for that particular organ. A final

compatibility test is done prior to the transplant using the monthly serum sample. If the laboratory does not

have a current sample, you may not be selected. If the crossmatch is acceptable, then the transplant can

take place if the size of the donor organ, the storage time, and the recipients health on that date are

acceptable.

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5. How long will I have to wait for a transplant?When a patient is listed for cadaveric transplant, they could receive a kidney the day they are placed on the

waiting list, or they might wait several years before receiving a kidney. Time spent waiting for a cadaveric

transplant varies by transplant center. In the thirteen Network 5 transplant centers, the median time that

patients waited for a transplant between January 1996 and June 2001 was 39.1 months. Median is defined

as the middle number in a range; as used here it means that half of the patients waited less than 39 months

and half waited longer than 39 months for their transplant. The shortest median wait was 9.6 months and

the longestmedian wait was 70.3 months. The number of months spent on the wait list at every UnitedStates transplant center can be viewed on the Internet at http://www.ustransplant.org/national.html. The

number of donor organs available, the number of patients listed for transplant, and the results of the

monthly PRA testing all affect wait time. When there is a living donor, surgery can be scheduled at a time

convenient to the donor and recipient as soon as medical evaluation and testing are complete. Generally,

the time waiting is much shorter with a living donor.

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What are the risks involved if I have surgery?

Any major surgery and general anesthesia can pose some risks to the patient. An extensive medical

evaluation is done to determine whether a patient is an acceptable candidate for surgery and for transplant.

Will I have a lot of pain? How long will I be in the hospital?

Most patients recover from kidney transplant surgery rapidly, and are ready to leave the hospital in a few

days, depending on the transplant center. While surgery is always associated with pain, there are varieties

of intravenous and oral medications that provide excellent pain control. Fear of pain should not be a reason

to decide against a kidney transplant!

Will I lose my disability benefits?

Some transplant patients are eligible for Supplemental Security Income (SSI) assistance and medication

grants. If the patient is currently receiving disability benefits, the Social Security Office can advise themon how frequently their file will be reviewed after transplant. If their medical condition improves, and they

are able to work, their benefits may stop. Individuals are allowed to work for nine trial months before

their final status is determined. The financial counselor at the transplant center can provide complete

information about how the disability program works.

Can a member of my family, or a friend, give me a kidney?

Yes, family members, distant relatives, spouses, or friends can donate a kidney to you. You can

receive a living related transplant (a kidney donated by a family member) or a living unrelated

transplant (a kidney donated by someone who is not a blood relative). Transplant centers look at many

variables when evaluating a possible living donor. Living donors must be healthy, free of kidneydisease, and have normal blood pressure. The best matches come from full siblings (brothers or

sisters), but transplants from the poorest matched living donor are more successful than the best

matched cadaver (non-living) donor. The transplant center will educate both the donor and the

recipient about what to expect during this process. Examples of areas evaluated by transplant centers

and OPOs are listed below.

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Blood Group; A, B, O compatibility determine the blood type of the donor and the recipient

and make decisions about whether the donor can be used

Cross match - mix samples of donors and recipients blood together on a slide and view under

a microscope to determine whether recipients cells try to destroy the donors cells

Donor and Recipient - Preliminary medical assessment extensive review of donors and

recipients existing and previous medical conditions to determine whether transplant surgery is

possible

Age, renal function, and anatomy acceptable? - Evaluate function, size and structure of thedonor kidney to determine whether transplant is possible

Psychosocial assessment assessment of mental and emotional stability of the prospective

donor to determine their ability to donate an organ

If all of the above assessments are found to be positive then Transplant surgery can take place.

10.What kind of outcomes can I expect after a transplant?The transplant center can provide outcome data on the performance of their program. Data on patient

survival, graft (the kidney) survival, infection rates, and complication rates are public record and are

available to the patient. To view survival data on the Internet go toThe Scientific Registry of Transplant

Recipients (SRTR) at http://ustransplant.org/.

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http://ustransplant.org/http://ustransplant.org/

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