Kidney Transplant & Living Kidney Donation

Many potential candidates for transplant are referred through their nephrologists or through their dialysis centers, however you may also “self-refer” by simply contacting us at 505-925-6371.  When you contact us, we will send you a packet of information about transplant and our program that is important for you to carefully review.  The packet will also include some papers that you will need to fill out and return to us.  When we receive your paperwork back, we will schedule you for your evaluation day.  While you are waiting for your evaluation day you can make sure that your own age-appropriate health maintenance exams are up-to-date, such as dental exam, colonoscopy, pap smear, and mammogram, as these will be required to be approved for transplant.

Your transplant journey will begin with an “evaluation day,” which will be scheduled for you when your paperwork is received by our transplant team.  These appointments are typically scheduled on a Thursday, and can take the entire day, as you will complete several tests and meet many new people.  You will be assigned a Pre-Transplant Coordinator who will facilitate your day.  This coordinator will remain with you on this journey up until you are approved to be listed on the national transplant list.  Some of what you can expect on evaluation day includes:  a physical exam by a Nephrologist or Nurse Practitioner, blood and urine testing, chest x-ray, EKG (heart test), and visits with your Pre-Transplant Coordinator, Social Worker, Dietician, and a Pharmacist.  At the end of this visit you will receive written instructions for any additional testing that your team determines will be necessary to make sure you are healthy enough for transplant.  It is very important that you maintain frequent communication with your Pre-Transplant Coordinator during this time. You can call or email  each of them at the following numbers: Christine Wilcox 505-272-4234 or Chwilcox@salud.unm.edu Mary Gallegos 505-272-0608 or Mwolff@salud.unm.edu  

Once you have completed all of your requested testing, we ask that you contact your Pre-Transplant Coordinator and let her know, so that she can prepare your information to be presented at a Listing Committee meeting.  This is a multi-disciplinary meeting where all of your results will be reviewed and a decision will be made if you are a candidate for Kidney Transplant.  Members of this committee may include the Transplant Nephrologist, Surgeon, your Coordinator, the Dietician, Social Worker, our Transplant Psychologist, and Pharmacist.  We will discuss your results in detail and make sure everyone agrees that transplant is right for you.  You will be notified of the decision the committee makes by your Pre-Transplant Coordinator.  The committee could decide that you are not a good candidate for transplant or that they need more information about you and your health.  Your health and well-being are the committee’s top priority. Your coordinator will call or send you a letter about the committee decision.

If you are approved by the committee as a transplant candidate, you will be placed on the Kidney Transplant waiting list.  You could be listed as active (Status 1) or inactive (Status 7).  Status 1 means you are approved for transplant, ready and awaiting an offer.  Status 7 means you are listed to gain time on the Waitlist, but you require additional testing or clearance for a transplant and will not yet receive an offer.  If you are placed on the list you will now be assigned a Listed Coordinator that will take over the following of your care until you are transplanted. Our listed coordinators are Kammi Rodriguez (505-272-5448, karodriguez@salud.unm.edu) and Cheryl Murdie (505-272-7815, cmurdie@salud.unm.edu).

While you are listed you will have some requirements to remain on the list:  You will need to have monthly blood samples drawn to check for antibodies (this may be drawn at your dialysis center).  You will need to come to visits with your Listed Coordinator at least yearly, or when scheduled.  You will also need to maintain your age-appropriate health care (dental, etc).  It is very important to maintain and work to improve your health so you can continue to be an appropriate candidate for transplant. 

This is the moment everyone is waiting for!  When you receive an offer for a kidney you will either be the “primary” recipient, or a “backup” recipient (in case something happens with the primary recipient).  You will have an hour to respond to your coordinator and decide if you want to proceed with the offer.  It is very important that you always give us your current contact information, have your phone charged, on, and ready to answer.  You can give us multiple contact people just in case we have trouble reaching one number.  You need to be prepared if you want to accept the offer, including having transportation plans, a bag packed for a 2 to 3 week stay in Albuquerque, your insurance cards, your cell phone and charger, medications, and any medical supplies that you need.  If you are the primary recipient, you will be admitted to the hospital.  If you are the backup recipient, you will come to the hospital to give a blood sample and need to stay nearby, but will not be admitted. 

Your surgery will take about 3 to 5 hours, and is a major surgery that involves risks.  These risks will be discussed with you during your education so that you can make an informed decision about whether this is right for you. After surgery you can expect to be in the hospital for an average of 7 days.  If there are complications you may be in the hospital for a longer period of time

After you are discharged from the hospital you must stay in Albuquerque for at least two to three weeks.  You will need to have someone with you to help care for you, and this person needs to be identified before surgery.   You will be assigned a Post-Transplant coordinator that you will meet either beforehand or while you are in the hospital.  There will be someone available to you 24/7 for medical or surgical issues after transplant.  You can expect multiple clinic and lab visits each week for several months.  You will be educated on any restrictions you will have while recovering, such as lifting restrictions.  You will have education on the dietary changes you can expect after transplant as well.  There will be many new medications to get used to after transplant and the pharmacist will discuss each of these with you so you know what to expect and are prepared for possible side effects.  The dosages of these medications can be changed frequently based on your lab results, especially right after transplant.  Your team will work with you to make sure you understand all this new information and changes that will take place.

Our post transplant coordinators are: Roberta Garcia (505-272-6273, rsgarcia@salud.unm.edu), Jonathan Duggan (505-272-8068, jdduggan@salud.unm.edu), Michael Oddo (505-272-3109, moddo@salud.unm.edu), and Monica Ross (505-272-3107, mjross@salud.unm.edu).

Your evaluation and testing are paid for out of a Kidney Fund, except for your normal health maintenance exams, which will be billed to your insurance.  Your transplant surgery costs and medications may vary based on your insurance plan, and these will be discussed with you by our Financial Coordinator so that you know what to expect ahead of time.  It is VERY important that you inform the Transplant team of ANY changes to your insurance during your transplant journey.  Some costs may not be covered by your health insurance when getting a transplant, such as travel to Albuquerque, hotel, food, and gas while you stay in Albuquerque, and medication co-pays.  Our Social Worker can discuss with you any help for these costs that you may be eligible for. 

It is impossible to determine exactly how long it will take for you to get a kidney on a deceased donor list.  The average wait time in New Mexico for a deceased donor kidney is about 4 to 7 years.  This time can vary based on your blood type or any antibodies you may have. 

Things like active cancer, chronic illness with a life expectancy of less than 1 year, active abuse of alcohol or drugs, untreated mental health conditions, or a body mass index of greater than 38 will exclude you from transplant at our center. Things that will be carefully considered and may exclude you include severe heart, lung, or vascular disease, active infections, proven non-adherence (you have not followed medical instructions like taking your medications or being compliant with your dialysis routine), or change in your health insurance. 

If you are going to receive a living donor kidney your body mass index will need to be at 37 or below.

• United Network of Organ Sharing   https://unos.org/

• Organ Procurement and Transplantation Network  https://optn.transplant.hrsa.gov/

• National Kidney Foundation  https://www.kidney.org/

• American Kidney Fund  https://www.kidneyfund.org/

• New Mexico Donor Services  https://donatelifenm.org/

To start the workup of a potential donor it is required that the intended recipient is already active on the transplant waiting list*  It is required for any potential living donor to make the initial contact with our team.  This contact needs to be made by the actual donor, and not the recipient on behalf of a living donor.  The initial interview is conducted by phone, and will be done by our Living Donor Coordinator, Lara Stagg, RN, or our Living Donor Social Worker, Evan Holm, LMSW.  This interview takes about 15 – 20 minutes.  It consists of asking medical questions, family history, statistical questions (may include race, etc.), and personal questions, so please call when you have the privacy to talk freely.  If nothing is uncovered in this interview that contraindicates you being able to donate, we will order some initial blood and urine testing that can be done at your convenience.

If your interview goes well and your initial lab results are normal, the next step in the process is an evaluation day.  These appointments are almost always on a Monday, and last all day.   You can expect to be at the hospital from 7am until 3:30pm.  You will bring a 24-hour urine sample with you that is collected the day before.  Your evaluation day includes an education class, more blood testing, another urine test, a CT Scan, a chest x-ray, an EKG (heart test), meeting with the transplant Social Worker and Dietician, and seeing a Nephrologist.  We will try to get all of your testing done in one day, however some testing may need to be ordered at a different time based on your results, age, or medical history.  Your normal health maintenance studies are required to be up-to-date to be approved as a donor, and must be ordered through your Primary Care or OB/GYN.  These could include Pap Smear, Mammogram, Prostate Specific Antigen testing or Colonoscopy based on your age and history. 

When all of your testing is complete, your Living Donor Coordinator will present all of your results at a Living Donor Selection Committee meeting.  Members of this committee may include the Transplant Nephrologist, your Coordinator, the Dietician, Social Worker, our Transplant Psychologist, and Pharmacist.  If after careful review of your testing you are approved medically as a living donor, your Coordinator will then present your information at a second meeting with the Transplant Surgeons.  At this meeting the Surgeons will review your CT Scan and decide if the blood vessels around your kidney are appropriate for transplant.  If you are approved at this meeting you will be given a surgery date.  You could be declined as a living donor at either of these meetings if there is concern that you would not be a good candidate for the surgery.  Again, your health and well-being is always our top priority.  Your Living Donor Coordinator will be in close contact with you to let you know what decisions are made at these meetings and answer any questions that you may have.

If you are approved and scheduled for living donor surgery, you will either have your surgery laparoscopically or you could possibly have an open procedure.  This will be decided by the surgeon based on your particular anatomy and which kidney they are going to remove.  If you have a laparoscopic procedure you will have 3 to 4 small incisions, and one may be a little larger to enable them to remove the kidney.  You would expect to be in the hospital for 2 or 3 days after surgery.  If you have an open procedure you would have one larger incision, and expect to be in the hospital around 5 days.  After surgery you will be asked to do things to minimize any risk of complications, like walking, coughing and deep-breathing, and keeping well-hydrated. 

After discharge from the hospital you would be free to return home, but need to have someone with you to help care for you for a few days.  You won’t be able to drive until you are no longer taking narcotic pain medication or are cleared by the doctor.  If you had a laparoscopic surgery and have a sedentary job you may be able to return to work as early as two weeks after surgery, otherwise you could expect to return to work in about four to six weeks. 

You will have two follow-up appointments about four weeks after surgery, one with the nephrologist and one with the surgeon.  If you are healing well you may not see the surgeon after this appointment, but you will be required to follow up with the nephrologist at 6 months, one year, and two years after donation.  Your kidney health will be checked at these appointments through blood and urine testing, and you will also have your blood pressure and weight followed to make sure you are staying in a healthy range.  Your Living Donor team will coordinate these appointments.  After your two year visit you will be followed by your Primary Care Physician at least yearly. 

Your evaluation testing, surgery, physician costs and two years of follow up care are paid for out of a kidney fund.  Your own health maintenance exams, such as pap smear, mammogram, colonoscopy, etc are scheduled outside of your transplant evaluation and billed to your insurance as usual.  There is always a chance of a health condition being uncovered during your evaluation that may warrant further treatment or testing and you would be responsible for those costs. 

Things that will make you unable to donate are a personal history of diabetes, current or active infectious disease process, active or untreated substance abuse, a BMI of 35 or less is required to begin testing, a BMI of 32 or less is required to be approved to donate, or cancer.  Things that may make you unable to donate are high blood pressure (especially if it requires more than one medication to control), a history of kidney stones, or certain illnesses that run in your family. 

This no longer means that you cannot help your intended recipient!  We participate in the Paired Kidney Exchange through the National Kidney Registry.  You and your intended recipient can be entered as a pair into this program and be matched with another pair, and participate in a “kidney swap.”  This program has helped thousands of recipients with willing but incompatible living donors receive transplants. 

You have the right to change your mind at any point in the process, and you don’t have to state why.  This information will not be shared with your recipient.  We want to make sure you make the decision that is right for you.

A person that donates their kidney to a stranger in need is called an altruistic, or “Good Samaritan” donor.  We will complete your evaluation as usual and if you are healthy enough to be a donor we will match you anonymously through the National Kidney Registry to a recipient in need. 

• National Kidney Registry  https://www.kidneyregistry.org/

• National Living Donor Assistance Center  https://www.livingdonorassistance.org/

• National Kidney Foundation  https://www.kidney.org/

• New Mexico Donor Services  https://donatelifenm.org/

• United Network of Organ Sharing  https://transplantliving.org/