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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
Unadjusted Probability Rates
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
Unadjusted Probability Rates
USRDS GRAFT Survival
Unadjusted Probability Rates
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%
3.
4.
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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9.
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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