OSF Saint Francis Medical Center

Peoria, Illinois

Pre-Transplant

Patient Referrals

Patients may be referred to OSF Saint Francis Transplant Services for consideration by their nephrologist, dialysis center, or by self-referral. Early referral is important. Good candidates for transplant include patients that have a GFR of 20 or less and patients who are currently on dialysis.

Please complete the online referral form, or you may print out and complete the referral form and mail to:

OSF Saint Francis Transplant Services
200 E Pennsylvania Ave., Suite 209                               
Peoria, IL 61603
Phone: (309) 655-4101  Toll Free: (800) 635-1440   Fax: (309) 655-2597
 

Indications for Kidney Transplant

  • Chronic kidney disease (CKD) stage 5
  • Glomerular filtration rate less than or equal to 20
  • Patients undergoing dialysis for treatment

Indications for Pancreas Transplant

  • Type I Insulin dependent diabetes
  • C-Peptide less than or equal to 0.9
  • No level of chronic kidney disease

Indications for Simultaneous Kidney & Pancreas Transplant

  • Chronic kidney disease (CKD) stage 5
  • Type I Insulin dependent diabetes
  • C-Peptide less than or equal to 0.9

Your Transplant Evaluation

Once we contact you for an appointment, please complete the attached application and return as soon as possible. In order to speed up the evaluation phase, please contact your primary care physician to schedule and complete the following:

  • Pap smear for all women over the age of 18 (schedule as recommended by your gynecologist)
  • Yearly mammogram for all women over the age of 40
  • Colonoscopy for all men and women over the age of 50
  • See your dentist to make sure you do not have any infection or abscessed teeth

The above evaluations are billed to your insurance. Please have all records faxed to:309-655-2597.

What to Expect at Your First Appointment

  • Please eat breakfast and take your medications as prescribed. There will be lab testing to complete, but eating before you arrive is allowed and encouraged.
  • Bring a snack and medications as you may need these throughout or after your appointment.
  • Bring your insurance cards
  • Bring your eyeglasses
  • Bring your current list of all medications, herbals, and vitamins
  • Just a reminder, you will be at this appointment for a minimum of four hours.

You will meet with the members of the team who will determine if you are a suitable kidney, pancreas, or simultaneous kidney pancreas/transplant candidate. The team is here to assess you medically, socially, and financially. Each member of the team provides education on their discipline and looks for any barriers in place. We want you to have a successful transplant experience.  It is very important for the recipient to be in the best health possible at the time of transplant.

Required Testing

The next step is to assess your medical suitability to be on the transplant list. You will be asked to have the following test performed:

  • Blood tests to determine blood type and tissue type (HLA)
  • Extensive lab work and testing infectious disease such as Hepatitis B & C, HIV, Tuberculosis and Syphilis
  • Chest x-ray
  • EKG
  • Colonoscopy if over the age of 50
  • Mammogram for women over the age of 40
  • Pap test and pelvic exam for women over the age of 18
  • Dental clearance or Panorex X-ray

Additional Testing That May Be Required

  • Heart testing such as echocardiogram, stress thallium test, or cardiac catheterization
  • Ultrasound of your abdomen to access your abdominal organs and check for gallstones
  • Doppler studies to evaluate the blood flow
  • PFTs to access your lung function
  • Computerized tomography (CT) or magnetic resonance imaging (MRI) scans may be needed

Other tests and screenings may be ordered as needed if test results are abnormal or if a medical or psychosocial condition suggests more evaluation should be done. You may be referred to:

  • Transplant cardiologist
  • Transplant psychiatrist/psychologist
  • Infectious disease
  • Gastroenterology
  • Urology
  • Pulmonary
  • Endocrine

Final Review by Transplant Selection Committee

After you’ve completed all the requested tests, your transplant coordinator will present you to the OSF Saint Francis transplant selection committee.  Each team member gives their opinion on your suitability as a candidate for transplant. You will be notified in writing whether or not you are approved.

If you don’t have an identified living donor, you’ll be added to the kidney transplant waiting list.  Once you are added to the transplant list, you should receive a letter in the mail notifying you that you are on the wait list. You will be required to be seen in re-evaluation as instructed by your coordinator, usually every one or two years.

Waitlist

United Network for Organ Sharing (UNOS) is a private, nonprofit organization under federal contract that manages the nationwide kidney transplant waiting list. When a donor becomes available, that person’s medical information is added to the list. The computer then matches the organ with someone on the waiting list based on blood type, how well they match the donor, and the length of time a patient has spent on the waiting list. Currently, the average wait time to get a kidney transplant from the deceased donor kidney list is approximately three to five years.

Multiple Listing

UNOS rules allow patients to register with multiple transplant centers. Each transplant center will require a separate medical evaluation, even if a patient is already registered at another center. You can check with your insurance provider to see if they will reimburse the cost of additional evaluations, listing costs, and transplant coverage at other centers. You should also consider the other costs associated with listing that insurance may not cover. For example, you may need to pay for travel and lodging if the center is farther from your home.

While You Wait

To prepare for a safe and successful transplant, there are many proactive steps you can take while you are waiting for an organ to become available.

  • Have your monthly serum drawn at your local hospital or dialysis center.
  • Take care of your health. Try to stay as healthy as possible.
  • Take your medicines as they are prescribed.
  • Keep your scheduled appointments with your physicians. Until your transplant, you will need to meet with members of the transplant team in order to evaluate your overall health.
  • Participate in support groups. Ask your social worker about support groups and other resources so you will have access to more information and other transplant candidates
  • Follow the dietary and exercise guidelines. Weight management is very important while waiting for your transplant. A dietician and physical therapist can work with you to plan and develop a diet and exercise program that will give you the greatest benefit before and after transplantation.
  • Change any harmful habits that may damage your new organ. We expect that you will avoid drugs and alcohol while you are on the list and after your transplant. We strongly encourage tobacco smokers to quit before your transplant.
  • Stay involved. You do not have to refrain from activities you enjoy. Spend time doing what you enjoy and stay as active as your physical condition will permit. Keep up with your work, studies, and/or leisure activities, or start a project or hobby that can help distract you and make time pass more quickly.
  • Maintain contact with family and friends. Good company will take your mind off of waiting and enrich your life.
  • Relax. Reading or listening to music or relaxation tapes can be helpful in taking your mind off your transplant and avoiding negative thoughts.
  • Manage pre-transplant stress. Share your feelings if you feel depressed or uneasy. The transplant team can answer questions and help alleviate fears.

It’s Important to Call the Transplant Office if:

  • Your telephone number or address changes.
  • Your insurance is scheduled to change.
  • You go on vacation.
  • You are ill, hospitalized, or receive a blood transfusion.
  • You receive any diabetic foot wounds or amputations.
  •  You start dialysis, change dialysis centers, change the type of dialysis, or you change nephrologists.
  • You become pregnant.

It is important that we have accurate information about how to reach you when an organ becomes available. Any changes or updates to your information should be immediately communicated to your transplant coordinator. If you decide to travel during your waiting period, you must provide your transplant coordinator the dates you will be away and all of the information we will need to reach you during your travels.

Preparing for the Call

Being prepared and ready will make the transition from regular life to surgery day and beyond much more stress-free. Prior to the call:

  • Have transportation prepared. When you are placed on the organ waiting list, your first responsibility is to plan how to get to the transplant center as soon as you are notified that an organ is available. Prepare yourself for this call by making the necessary arrangements for transportation well in advance.
  • Make prior arrangements for children and/or pets so you can leave in a moment’s notice.
  • You must have a working telephone. Team members also need the telephone numbers of friends, relatives, and neighbors who can locate you when needed. We have a limited amount of time to get ahold of you. If we are unable to reach you, we may need to pass on the potential organ offer.

Getting the Call

You may be called to the hospital at any time. Our surgeons are available twenty-four hours a day, seven days a week, every day of the year for you whenever an organ becomes available. The transplant coordinator will perform wellness calls prior to officially calling you in for transplantation.  If you are on dialysis, we will review your current health status and compliance. Then, we will ask you the following:

  • Have you had any recent illnesses?
  • Have you had any recent infections?
  • Have you received any recent blood transfusions?
  • How long will it take you to reach the hospital?
  • When was the last time you had anything to eat or drink?

In most cases you will arrive four hours prior to surgery. The transplant coordinator will direct you to what entrance of the hospital to use and where to go from there. Do not eat or drink anything as directed by the transplant coordinator.

Bring the Following Items With You When You Come to the Hospital For Your Transplant:

  • Current medication list including medications, herbals, and vitamins
  • All of your medications
  • Insurance cards
  • Loose, comfortable clothing and comfortable shoes for you to wear after surgery
  • Pajamas, robe, slippers if you desire
  • Any personal hygiene products you may need

Day of Surgery

Before Surgery

Once you arrive in admitting at OSF Saint Francis Medical Center, you will be registered. Transport Services will assist you to your room on the Urology/Transplant Floor.  Your transplant nurse will prepare you for surgery. An IV will be started and blood work drawn. Other testing that will be performed includes:

  • Chest X-ray
  • EKG
  • Urine sample, if you are able
  • Updated history and physical exam

Loved ones are welcome to come with you to the hospital and may stay with you until you go for surgery.  You can expect multiple visits from your nurses and physicians, because they want information about your health history to better prepare you for surgery. You will be given surgical education, and you will need to sign consent forms for the potential procedures.  If the physician finds a medical problem such as an infection or an incompatible cross-match, the surgery cannot be performed, and you will be discharged home.

During Surgery

Once you receive general anesthesia and have fallen asleep, the transplant surgeon will open the right or left side of the abdomen and connect the kidney. The surgeon attaches the donor vessels to the main vessels nearby, and the ureter is attached to the bladder.

A special IV called a central line will be placed in the large vein near the collar. Your central line with remain in place for the duration of your stay to receive fluids and other necessary medications. Another tube called a foley catheter will be placed in the urinary bladder. This catheter will drain the urine continuously, so that the bladder does not become too full. We are able to measure the urine that the new kidney is producing. The urine may be blood-tinged or have blood clots which are normal after surgery. The surgeon will decide how long you need to have the catheter in place.

A stent may be placed in your ureter. The purpose of placing this plastic tube is to protect the connection between the newly transplanted kidney and urinary bladder. The stent may be removed approximately six weeks after your transplant. This can usually be done in an outpatient setting with mild sedation.

It is not necessary to remove the old kidneys. Kidney transplant surgery lasts approximately three to four hours and kidney/pancreas surgery lasts approximately eight to ten hours. Your family will be updated regularly regarding your status.

Immediately After Surgery

You will go from operating room to recovery room. Once you have stabilized and are awake, you will return to your room on 2400 (renal floor). In special circumstances, you may go to the intensive care unit. Once in your room, floor staff will familiarize you with your belongings, the menu/room service, and the nursing call system.

The nurses will encourage you to cough and breathe deeply. They will educate you on how to use an incentive spirometer. This is very important to help reduce the risk of developing pneumonia.

Pain medication will be given through the IV. The pain medication is on a special pump that allows you to push a button and receive a pre-set amount of medication. The pump can only deliver a certain amount of medicine at certain times.

Some patients will have a nasogastric tube (NG tube) placed through the nose and into the stomach. This tube is to drain the stomach and help reduce nausea and vomiting.

The nursing staff will get you out of bed the evening after surgery or the following morning. You may progress to walking in the hallway on your own. This is to reduce the risk of developing blood clots and pneumonia.

Recovery

During recovery, surgeons, doctors, social worker, nurses, pharmacists and residents will visit you daily to discuss your progress and plan of care. Time will be set aside each day for the transplant nurse and a caregiver to meet with you to go over education materials, medication, labs, and clinic appointments.

Usually, the new organ(s) will start working right away. Sometimes, it may take several days for the donor organ(s) to start functioning. If this were to occur, you would be dialyzed until the new kidney begins to work. The average length of stay in the hospital for a kidney transplant is three to six days. For a kidney/pancreas transplant, the average length of stay is six to ten days.