Talk with your child’s healthcare team to see if a transplant is an option for your child. If it is, then have your child’s provider refer you to a transplant center in your area. Transplant centers are located in certain hospitals throughout the U.S. Your child must complete a full evaluation at the transplant center.
Your child will have a variety of tests done by the transplant center team. This is the group of specialists who evaluate people to see if they can have a transplant procedure. They also care for people undergoing a transplant. The team will decide if your child is a candidate for a transplant.
The transplant center team will include:
- Transplant surgeons. Doctors who specialize in transplantation and who will be performing the surgery. The transplant surgeons coordinate all team members. They follow your child before the transplant and continue to follow your child after the transplant and after discharge from the hospital
- Nephrologists. Doctors who specialize in disorders of the kidneys. Nephrologists will help manage your child before and after the surgery
- Urologists. Doctors who specialize in diagnosis and treatment of disorders of the genitourinary tract
- Transplant nurse coordinator. A nurse who organizes all aspects of care provided to your child before and after the transplant. The nurse coordinator will provide patient education and coordinate the diagnostic testing and follow-up care
- Social workers. Professionals who will provide support and guidance to your family as you deal with many issues that may arise, including lodging and transportation, finances and legal issues. They can also help coordinate alternative means for school, so that your child does not fall behind
- Dietitians. Professionals who will help your child meet his or her nutritional needs before and after the transplant. They will work closely with you and your family
- Physical therapists. Professionals who will help your child become strong and independent with movement and endurance after the transplantation
- Chaplaincy services. Chaplains who provide spiritual care and support
- Other team members. Several other team members will evaluate your child before transplantation and provide follow-up care, as needed. These include, but are not limited to, the following:
The Transplant Evaluation Process
An extensive evaluation must be done before your child can be placed on the national transplant waiting list. Testing includes:
- Blood tests
- Diagnostic tests
- Psychological and social evaluation of the child (if old enough) and the family
Tests are done to gather information that will help determine how urgent it is that your child is placed on the transplant list. These tests also ensure your child receives a donor organ that is a good match. Tests include those to analyze your child’s general health, including:
- Heart, lung and kidney function
- Nutritional status
- The presence of infection
Blood Tests
Blood tests will help improve the chances that the donor organ won’t be rejected. These tests may include:
- Blood chemistries. These may include serum creatinine, electrolytes (such as sodium and potassium), cholesterol and liver function tests
- Clotting studies, such as prothrombin time (PT) and partial thromboplastin time (PTT). These tests measure the time it takes for blood to clot
Other blood tests will help improve the chances that the donor organ will not be rejected. They may include:
- Your child's blood type. Each person has a specific blood type: type A+, A-, B+, B-, AB+, AB-, O+, or O-. When receiving a transfusion, the blood received must be a compatible type with your child's own. If not, an allergic reaction will occur. The same allergic reaction will occur if the blood contained within a donor organ enters your child's body during a transplant. Allergic reactions can be avoided by matching the blood types of your child and the donor
- Human leukocyte antigens (HLA) and panel reactive antibody (PRA). These tests help figure out how successful an organ transplant may be. The tests check for antibodies in your child's blood. Antibodies are made by the body's immune system in reaction to a foreign substance, such as a blood transfusion or a virus. Antibodies in the bloodstream will try to attack transplanted organs. Children who receive a transplant will take medicines that decrease this immune response. The higher your child's PRA, the more likely that an organ will be rejected
- Kidney, liver and other vital organ function tests
- Viral studies. These tests determine if your child has antibodies to viruses that may increase the likelihood of rejecting the donor organ, such as cytomegalovirus (CMV). Many other infectious diseases are also tested for, including HIV and hepatitis
Diagnostic Tests
Extensive diagnostic tests are also done. They are needed to understand your child’s complete health status. Other tests may also be done, including the following:
- Kidney ultrasound. For this noninvasive test, a probe (transducer) is passed over the kidney on the outside of the body. The probe creates sound waves that bounce off the kidney. The sound waves transmit a picture of the kidney onto a video screen. This test is used to determine the size and shape of the kidney. It can also see if there is a mass, kidney stone, cyst or other blockage or abnormality
- Kidney biopsy. Tissue samples are removed (with a needle or during surgery) from the kidney and checked under a microscope
- Intravenous pyelogram (IVP). A series of X-rays of the kidney, ureters and bladder. Contrast dye is injected into the vein to find tumors, abnormalities, kidney stones or any blockages, and to assess renal blood flow
Getting on the List
The transplant team will consider all the information gathered from interviews, your child's medical history and the evaluation tests. Based on this information, the team will decide if your child is a transplant candidate. If your child is a candidate, the transplant team will add him or her to the national transplant waiting list. If you have any questions about your child’s place on the list, ask the transplant team.