Live Kidney Donor Assessment and Donation Royal Infirmary of Edinburgh The Transplant Unit in Edinburgh provides live donor kidney transplantation services for the East of Scotland. Potential donors from outwith the local area will undergo the majority of their assessment at a unit close to where they live. However all live kidney donors will attend at least once to an outpatient appointment in Edinburgh prior to surgery. The assessment process is similar for both directed donors (donating to a relative or friend) and altruistic donors (donating to someone on the national waiting list whom you do not know). Initial Approach When a relative or friend is diagnosed with kidney failure, one of the issues that may be raised is the possibility of a kidney transplant. Many (but not all) of patients with kidney failure benefit from a transplant. The kidney doctor (Nephrologist) will discuss with the patient the transplant option and referral to the Transplant Service for further assessment. Potential live kidney donors can contact the Live Donor Transplant Co-ordinator team directly for an information pack to be sent. A health questionnaire within the pack should be completed and returned, if you wish to take the process further. When the health questionnaire is returned you will receive a letter acknowledging that we have received it. If, for some reason, it is felt that it would not be either the correct time or the potential donor is not suitable for assessment due to obvious health reasons, this will be discussed over the telephone and a letter confirming this discussion sent. Appointments An appointment will generally offered in the first instance for the nurse-led clinic. At the nurse-led clinic you will be seen by one of the Living Donor Transplant Co-ordinators. During this appointment you will be given information concerning the risks and benefits of live kidney donation, your general health and well-being discussed, and initial blood and urine tests may be performed if appropriate. This appointment is usually in Out Patient Department 4 in the Royal Infirmary of Edinburgh, but please check your appointment card. If a number of potential donors have come forward for one recipient, we do not progress more than one person through the assessment process, as this would unnecessarily expose healthy people to radiological investigations. During this initial visit, discussions will take place as to the most suitable person to proceed. A number of factors, such as blood group and tissue type matching, age, health, social situation are all considered. Pending the results of this initial visit, an appointment will be arranged for the potential donor to be assessed by a Consultant Transplant Surgeon or Consultant Nephrologist. This appointment is usually in Out Patient Department 1 in the Royal Infirmary of Edinburgh, but please check your appointment card. In some circumstances you may also be reviewed by a Consultant Transplant Psychiatrist, to ensure that donating a kidney will not adversely impact upon short and long term psychological wellbeing. Medical Day Case Pending all initial reviews being satisfactory, we will arrange for you to come to the Medical Day Case Unit at the Royal Infirmary of Edinburgh for further tests. You will usually be invited to attend on a Thursday at 8.30am, and we ask that you do not eat or drink (other than water) prior to having the first set of bloods done (this is to check for a fasting blood sugar level). After this test has been done you are allowed to eat and drink, so please feel free to bring a snack with you. During this admission the following tests will be completed: Chest X-Ray ECG (tracing of the electrical activity of the heart) Blood and urine tests Isotope Glomerular Filtration measurement (GFR) – This test assesses the ability of the kidney to ‘clear’ the blood of a particular substance. It gives an overall measure of kidney function, allowing us to determine whether we can safely remove one and leave you with good kidney function for the rest of your life Differential kidney function scan (DMSA) – This test involves an injection of radioisotope agent followed by a scan to assess the contribution of each individual kidney (split function) to the overall renal function. CT angio – Computerised Angiography (CT) reveals the number and size of blood vessels taking blood to and away from the kidneys, and shows detailed anatomy of the kidneys. This provides the surgeon with a ‘map’ of your kidney and helps decide which kidney is suitable to remove with minimal risk to you and to ensure safe transplantation in the recipient. This test is performed in the CT scanning department. Iodine containing “dye” is injected into a vein in the arm and the scan is performed. A computer is then used to build a 3-dimensional view of the kidneys and blood vessels. It is likely that you will be finished these tests in the early afternoon, after which you are free to leave. Multi-Disciplinary Team Meetings All your test results will be discussed at a Multi-Disciplinary Team Meeting. These meetings are held every Tuesday, and are attended by Consultant Transplant Surgeons, Consultant Nephrologists (kidney specialists), Consultant Transplant Psychiatrist, Consultant Haematologist, Transplant Co-ordinators, Tissue Typing Specialists and other specialities when required. The team reviews all results, and where necessary will recommend further investigations that may be required for both donor safety and transplant success. If the test results are acceptable then a recommendation will be made to proceed for further review by a Consultant Transplant Surgeon and to Independent Assessment. Human Tissue Authority and Independent Assessment It is a legal requirement that approval is obtained from the Human Tissue Authority (HTA) prior to any live donor transplant in the United Kingdom. For further details about the Human Tissue Authority please visit www.hta.gov.uk. In summary, the role of the HTA is to ensure the following conditions are met (referring to transplantation in Scotland): No reward has been or is to be given in contravention of section 20 of the Human Tissue (Scotland) Act 2006, which prohibits commercial dealings in parts of the human body for transplantation; There is no evidence of duress or coercion affecting the donor’s decision; and The relevant requirements of the Regulations (Scotland) under the Human Tissue (Scotland) Act 2006 have been met. What is an Independent Assessor and what is their role? Independent Assessors are trained professionals who are often based in hospitals with transplant centres or renal units. Once accredited by the Human Tissue Authority, they act as a representative of both the donor and the Human Tissue Authority. Independent Assessors interview potential donors and recipients to ensure the requirements of the Human Tissue Acts and associated Transplant Regulations have been met. Independent Assessors submit a report of their interview to the Human Tissue Authority and the Human Tissue Authority then make the decision on all cases. An appointment will be arranged for you to meet the Independent Assessor at an Out-Patient Department in the Royal Infirmary of Edinburgh. You will be advised prior to this appointment on the necessary paperwork to bring, such as photo ID, birth certificate or marriage certificate if appropriate. Altruistic donors are only required to bring photo ID. Pending final Surgical Review and approval from the Human Tissue Authority a date for the transplant operation will be discussed with you. Reimbursement of Loss of Earnings and Travel Expenses It is possible to claim loss of earnings, travel, parking and accommodation expenses. The Living Donor Transplant Co-ordinator will provide you with an information pack and appropriate forms to complete. Please note that you are required to provide all receipts and proof of attendance for claims. If you wish to make a claim, please let the Coordinator team know at an early stage, as this this requires agreement with the healthcare team caring for the recipient. What Happens Next? It is important to remember that many people who come forward as potential live donors do not proceed to donation. There can be many reasons for this, including finding a medical condition that the donor was previously unaware. Whatever the reason, the act of offering to donate a kidney is greatly appreciated by all involved in the process. If all your tests are satisfactory and everyone is in agreement to proceed, arrangements will be made for your admission to The Royal Infirmary of Edinburgh. The Transplant Unit in Edinburgh provides kidney transplantation services for the East of Scotland, and liver, pancreas and islet transplantation for all Scotland. The Transplant Ward is based in Ward 206, and the Transplant High Dependency Ward 117. Useful telephone numbers are available at the back of this information booklet. Prior to your admission you will receive a letter confirming your admission date and where to attend. Please note that this is different for donor and recipient, the donor will not usually be required to stay in hospital the night before surgery. Day Surgery Unit The day before your operation you will be asked to attend the Day Surgery Unit at the Royal Infirmary of Edinburgh, usually at 11am. A member of the nursing staff will check your details, arrange blood and urine tests, check your blood pressure and arrange for you to attend for an ECG. You will meet with Live Donor Coordinator to guide you through the admission. You will meet the Consultant Transplant Surgeon to discuss your operation and obtain written consent from you. The Consultant Anaesthetist will meet you to discuss your anaesthetic. It is important to mention to the Surgeon and Anaesthetist if you are on any medication and check if you should take it on the morning of your operation. When these tests and discussions are complete you will be free to go. If you require accommodation within the hospital please speak to the Living Donor Co-ordinators at least two weeks prior to the operation date. Please note the hospital accommodation available is a single room with shared bathroom facilities. There are also local Guests Houses and Hotels close to the hospital. Please ensure that you drink plenty fluids on the day before your operation, and avoid foods that may cause you to be bloated, such as high fibre or spicy foods, and fizzy drinks. The Day of the Operation Please attend the Day Surgery Unit, as above, at 7.30am on the morning of your operation. The surgeons and anaesthetist will see you and check final details before surgery. You must not eat or drink anything after 12 midnight, please do not chew gum or suck sweets. Please have a bath or shower prior to coming to hospital, and do not wear any make-up or nail varnish, please remove jewellery (except a wedding ring) and body piercings. Storage space is limited, so please just bring the basics: slippers, dressing gown, nightwear and toiletries. This will be enough for the first couple of days and you can ask your family to bring in comfortable clothes and shoes after surgery. Please do not bring valuables with you as there is no facility for safeguarding property whilst in Day Surgery. We strongly advise you to stop smoking if you are wishing to donate a kidney. If you have not managed this, please do not smoke for at least 24 hours before your operation. The Day Surgery Unit is a mixed sex ward with separate toilet facilities. The staff are committed to protecting your privacy at all times. The Operation A member of the theatre staff will come to the Day Surgery Unit to take you along to theatre. You will meet a member of the anaesthetic team who will put a small cannula in your arm for the anaesthetic to be administered. The operation usually takes 3-4 hours. Your surgeon will have described the type of operation you are to have in the clinic and again in the Day Surgery Unit the day before surgery. The donor nephrectomies (kidney removals) in our unit are performed by keyhole surgery (laparoscopic) but there is always a possibility of conversion to open surgery in about 2%-3% of the cases to ensure the operation proceeds safely. You will have 2 -3 small scars where the instruments have been placed, and one larger scar measuring between 5-7cms through the kidney has been removed. The placement of the scars will be discussed in detail with you prior to surgery as there are slight variations depending on whether the right or left kidney is removed. Following the operation you will be transferred to the recovery area. You will have an intravenous drip, an oxygen mask, a urinary catheter (small tube going into your bladder) and a Patient Controlled Analgesia device – so you can press a button when you require painkillers. There will be a monitor recording your heart rate, checking your oxygen levels by a clip on your finger and your blood pressure with a cuff round your arm. You will be transferred back to the High Dependency Unit when the theatre staff are happy that you are awake and recovering from your anaesthetic. High Dependency Unit (HDU) Ward 117 is the Transplant High Dependency Unit, on occasion you may be transferred to another HDU such as Ward 115 or Ward 116, depending on the bed situation. All High Dependency Units are mixed male and female. It is not always possible for you to be in the same ward as your recipient, but staff will facilitate you speaking on the phone and visiting when appropriate. You will be closely monitored in the HDU, as in the recovery area, and there is a ratio of 1 nurse to 2 patients. Visiting is allowed, but it is recommended to keep to close family and no more than 2 to a bed. You will be quite drowsy the first evening following surgery, and it is important to share with the nursing and medical staff if you are in pain, feel unwell or have any unexpected symptoms. The day after your operation you will usually be encouraged to sit up on a chair, and if all is going well then the drips and catheter may be removed. You will be transferred up to the ward when the Transplant Unit staff are happy that you have recovered sufficiently, usually 1 -2 days post operation. Transplant Ward Ward 206 Transplant has a number of single rooms and some 4 bedded rooms, which are always either male or female, not mixed. There is a toilet in each 4 bedded area. Over the next few days you will be encouraged to mobilise around the ward. It is important to remember that although your surgery was keyhole, it is still a major operation and you will take some time to fully recover. You will be reviewed every day by the ward round, which consists of the multi-disciplinary team, including Consultant Transplant Surgeons, Consultant Nephrologists and Nursing Staff. The ward round starts at 8.30 in the morning. The Transplant Co-ordinator will come and see you before you are discharged and provide further information. Useful Information for Visitors Telephone numbers Ward 117 – Transplant High Dependency: 0131 242 1171 Ward 115 – Renal High Dependency: 0131 242 1151 Ward 206 – Transplant Unit – 0131 242 2068 It is useful to have one or two people only phoning and passing on the information to other family members. The staff are limited as to what information can be shared by telephone. Visiting hours – 2pm – 8pm (please avoid visiting at mealtimes). Only 2 visitors per bed. Please, no flowers in either High Dependency or Transplant Unit due to infection control. As with all hospital visiting, please do not visit if you are unwell, have vomiting/diarrhoea or cold/flu symptoms.
