OSF Saint Francis Medical Center

Peoria, Illinois

Considering Transplantation

When your kidneys fail, you need one of two treatments to stay alive: a kidney transplant or dialysis therapy (either peritoneal dialysis or hemodialysis). You will often hear our transplant team say, “transplant is not a cure, it is a treatment option.” Transplantation has many advantages, and for many patients experiencing kidney failure, it is a viable and preferred treatment option.

A successful transplant eliminates the need for dialysis and helps patients enjoy an improved quality of life that leads to more freedom, energy, and productivity. Patients who receive transplants are more likely to return to work than patients who stay on dialysis. Most patients who have been on dialysis report having more energy, a less restricted diet, and fewer complications once they received a transplant than they had when they were on dialysis. One goal of transplant is to halt the progression of further disease. Although transplant cannot undue any complications caused by renal failure, successful kidney transplantation treats your kidney failure and gives you back your health.

Many patients believe they can live forever on dialysis; unfortunately, that is not the case. While dialysis is a lifesaving treatment, it only performs approximately 10 to 15 percent of the work a functioning kidney does. The transplanted kidney works 24 hours a day to remove 50 to 85 percent of the total waste your body generates. Ultimately, kidney transplantation is the preferred treatment option for patients who qualify.

Who Qualifies for Transplant?

Upon receiving a referral, each potential transplant recipient is evaluated on an individual basis. Our team takes a critical look at your medical history, social support, and compliance with medical regimen as we determine if transplant is your best treatment option. Some patients assume they are too old for transplant, but if they are otherwise healthy, age is not a factor in determining transplant eligibility. There are, however, some factors that may prevent patients from getting a kidney transplant:

  • Current life expectancy of less than five years
  • History of cancer
  • Severe cardiac, liver, or pulmonary disease
  • Active infection
  • Morbid obesity
  • Untreatable psychiatric illness
  • Non-compliance with medical regimen
  • Active substance abuse (alcohol or drugs)
  • Lack of adequate financial resources or medical insurance
  • Inability to understand and follow transplant recommendations
  • Lack of adequate social support

You and your transplant doctor will discuss your eligibility during the transplant evaluation process.

Advantages of Transplant over Dialysis

Dialysis has an impact over time on your body. It can cause serious health problems and complications. Dialysis patients are closely monitored for anemia, high blood pressure, nerve damage, bone disease, and infection. Due to this impact, the average life expectancy for a patient on dialysis is reduced.

Another option for a patient with end stage renal disease is to receive a kidney transplant. Patients can receive a kidney from a living donor or a deceased donor. Research has shown that in general patients who receive a kidney transplant live longer than those who remain on dialysis. In addition, most patients who have been on dialysis and then have a transplant report that they have more energy, fewer dietary restrictions and an increase in quality of life. Transplant patients are more likely to be able to return to work. Being off dialysis can allow patients to have more freedom to travel. However, in some instances transplant may not be the best option due to other risk factors or frailty. Our transplant team can answer any questions about what is the best therapy for you.

Transplant Risks

Organ transplantations are major surgeries. As with any surgery, there are risks. Possible complications can include: bleeding, infection, and blood clots. Sometimes the kidney does not work right away and needs time to recover before it can function properly. In these instances, dialysis would be performed until the new kidney begins to work.

Some types of renal disease can reoccur in the transplanted kidney. Your surgeon and transplant nephrologist will closely monitor for any signs of reoccurrence. There is a slight risk of certain types of cancers, including skin cancer and post-transplant lymph proliferative diseases or lymphoma, because of the anti-rejection medicine that is used to protect the kidney from rejection. Your transplant team will monitor your progress very closely to ensure you receive the very best care.

Insurance and Financial Considerations

The financial impact of needing an organ transplant can be a source of anxiety and concern for patients and their families. Our staff understands the importance of financial stability for our patients and therefore has included financial issues as part of our patient care services. In addition to the general information that our clinical staff can share with you, we have qualified staff members who specialize in helping you understand and navigate this important part of your care.

Transplant financial coordinators are unique to organ transplant. Their role is to provide education and counseling on all aspects of the transplant process from a financial perspective. They collaborate and communicate with insurance companies, Medicare, Medicaid, and with various members of the transplant team in order to provide a complete financial plan of care for each individual patient. They are a valuable resource for information regarding all financial aspects of transplant. Every potential transplant patient will have an opportunity to meet with a financial coordinator as part of the routine evaluation process. They will remain an important member of your health care team, often working behind the scenes but always available to you upon request.

Before your first appointment, a financial coordinator will contact your insurance company to verify benefits and get approval for the initial evaluation. At your visit, they will meet with you to verify that the information they have received is current and correct. They will also:

  • Review your benefits with you, including copays, deductibles, and out of pocket maximums.
  • Review coverage for immunosuppressive medications and other costly medications.
  • Discuss the benefits of supplemental insurance.
  • Discuss Medicare eligibility due to end stage renal disease.
  • Provide information about additional resources.
  • Answer any questions or concerns you may have.

The financial coordinator will also ask you more detailed questions in order to get a complete picture of your current financial situation and how transplant may affect you financially. The following information will be needed:

  • Your total monthly income
  • Your source of income
  • Number of household dependents
  • Employment status or reason for disability
  • Spouse’s employment status
  • Military history

This information will allow the financial coordinator to review with you any additional assistance that may be needed as well as providing you with any other options.

Frequently Asked Questions

“Will my insurance company pay for my transplant?”

Most insurance carriers, including Medicare and Medicaid, pay for kidney transplants. If Medicare is your primary insurer, your transplant must be at a Medicare approved center. OSF  Saint Francis Medical Center is a Medicare approved center for organ transplant.

Most transplant patients are eligible for Medicare based on ESRD and can apply at the time of transplant. The benefits are backdated to the first of the month the transplant was received. Medicare may be the primary insurer or secondary based on the “Coordination of Benefits” ruling.

If you would like additional information, you may download a copy of the official government booklet, “Medicare Coverage of Kidney Dialysis and Kidney Transplant Services.”

“How will I pay for my prescription and non-prescription medications?”

This is one of the most important questions that you will need to answer prior to transplant. If you cannot get your prescription medications after your transplant, your transplant will most likely fail. If you have Medicare at the time of the transplant and Medicare is primary, your immunosuppressive medications will be covered at 80% under Medicare B. You will be responsible for the remaining 20 percent copay if you do not have a Medicare supplemental policy in effect. Even if you have a prescription plan, it may not cover your medications at 100 percent. Out of pocket costs for prescription medications can be over $500 for the first few months post-transplant and continue from $200 to $500 for the life of the transplant. Assistance may be available through pharmaceutical companies, Extra Help through Social Security LIS, or several transplant-specific funding sources. The financial coordinator and the social worker will discuss the options available to you in more detail when they meet with you.

“What if my insurance changes?”

If your insurance changes, you must notify the financial coordinator immediately. The transplant center will need to get approval from your insurance plan prior to your transplant. If you change insurance and do not tell us, we may not be able to get the approval needed. Without proper approval, the insurance company may deny payment for the transplant and all of your aftercare.

“Are there any ‘hidden’ costs I should be aware of?”

There are some ‘hidden’ costs that you need to be aware of. These include, but are not limited to:

  • Transportation to and from the transplant center before and after the transplant
  • Food and lodging for you and your family
  • Lost wages
  • Childcare

Reminder: Medicare coverage, based on end stage renal disease, ends three years post-transplant.