Kidney Transplant Evaluation and First Visit

Natasha Perez: Hi, my name's Natasha Perez. I'm a kidney transplant coordinator here at The University of Kansas Health System. And welcome to your pretransplant education class. Here we have pictured our kidney transplant nephrologists and our nurse practitioner. You'll be seeing 1 of them during your transplant evaluation. Don't forget during your transplant evaluation to bring your medication list. And if it is your personal list make sure your name and date of birth is at the top.

Natasha Perez: Today, we'll be talking about transplant facts and terms, the transplant surgery itself, getting through the evaluation process, what it's like to be on the wait list and the updates that are required, the types of kidney donors you can be offered, the transplant hospitalization and a brief overview of the post-transplant care. Some terms we're going to be talking about is the Center for Medicaid or Medicare, also known as CMS. We'll also be talking about the United Network for Organ Sharing or UNOS. Lastly, we'll also talk about the Midwest Transplant Network or MTN. 

Natasha Perez: So first, Medicare. It is a benefit you can carry that also helps you cover the cost of your transplant evaluation, the surgery itself and your immunosuppression after transplant. We do meet all of the requirements for CMS. So your benefits are maximized here at The Health System.

Natasha Perez: The United Network for Organ Sharing or UNOS is the organization which facilitates organ sharing and transplant. They establish the fair organ sharing policies that all transplant centers meet. They also maintain that national wait-list that everyone is on. They also collect data and put it out there for the world to see, and we will talk later about where you can access that information.

Natasha Perez: MTN or the Midwest Transplant Network is a non-for-profit organ procurement organization. They work at the bedside of the donors and with the donor families. They cover all of Kansas and half of Missouri. They also raise awareness about the need for organ and tissue donation.

Natasha Perez: Next are our transplant outcome reports or the scientific registry of transplant recipients or also known as SRTR. This is where UNOS reports all of the transplant performance data on the website. You can find the patient and organ survival rates at the one five in tenure marks on this webpage. You just go to srtr.org. What you'll look up is the transplant center you would like to be wait-listed with, and you can see graphs that show what is expected on a national average and how that center performs. If you have any difficulty navigating this website or finding it, please just contact your nurse coordinator and they can assist you.

Natasha Perez: Some transplant facts. There is at any given time, about 100,000 people waiting on the kidney transplant wait-list. Every year, approximately 18,000 transplants occur. Of that 18,000, 12,000 typically come from deceased donors and 6,000 typically come from living donors. Due to this gap in the 18,000 transplants that occur every year and the a 100,000 people that are waiting, is why our wait time, here in the Midwest is about 2½ to 3 years, depending on your blood type. Due to that wait time, unfortunately about 4,000 people do pass away waiting for an organ transplant. There are 2 options in order to receive a kidney transplant. You can either wait for a deceased kidney transplant and that is what the wait-list is intended for. Or you can find a living donor transplant. So you would find someone healthy enough to be able to donate a kidney to you.

Natasha Perez: It is the gold standard here to find a living donor transplant. It is the best treatment option for you in regards to a renal transplant. You typically will have a shorter wait time because you're only waiting for that donor to get through the process of approval. You will also have a scheduled transplant surgery instead of a random phone call in the middle of the night calling you in for an organ offer. You also will have a longer kidney function with a living donor transplant. Living donor kidneys are more likely to last 15 to 20 years versus a deceased donor, which lasts about 10 to 15 years. You typically will have fewer complications and better matching options with a living donor transplant.

Natasha Perez: A big question that everyone asks is does my living donor have to have the same blood type as me, and that is no. We are more concerned with you focusing on trying to find someone healthy enough to donate to you. If that person in the end does not have the same blood type as you, it is okay. We have other candidates here at the health system that also are in the same situation. So if we just change, if we take 2 people and change around the donors, everyone will walk away with a kidney transplant from a living donor.

Natasha Perez: Other questions that are asked, does my donor have to live locally? And the answer is no. They can complete most of their testing back home where they live. Also, does my donor have to pay for their medical workup or surgery? And the answer is no, your insurance will cover any testing needed and the transplant surgery. Is there any assistance for travel or lodging? And that just depends on your benefits with your insurance company. The living donor team can answer any further questions you may have in that is noted there at the bottom of the screen.

Natasha Perez: Some resources that we have available and can give to you when you come for your transplant evaluation is we have a packet about the Big Ask, Big Give. They have a website you can also put in the search engine and look and find resources there about living donation and kidney transplantation. We also have living donation cards to help raise awareness to everyone around you about that you're in need of a kidney transplant and how to contact if they are wanting to help.

Natasha Perez: So the kidney transplant itself. We will leave your native kidneys, or your original kidneys, in place. They're located in the middle of your back beneath your rib cage, and we will put the new kidney transplant down low in your abdomen by your hip bone. This is a smaller incision than thought. It is only about 4 inches long. It's about the shape of a checkmark or a hockey stick. We close the incision with staples so don't be alarmed if you are to wake up with a drain in place, that is just to aid in the healing process. If you're a Type 1 diabetic, we do offer a kidney and pancreas transplant. The incision is slightly different. It is going to be a larger surgery. You're receiving more than 1 organ. So you'll have a large midline incision and you will also require a stay in the ICU for closer observation.

Natasha Perez: We do participate in clinical studies here at the health system. There are benefits to participating. You'll have access to new treatment options such as new immunosuppression medication. Also, you'll help in discovery of new treatments and improve future transplant care. It is completely up to you, it is not mandatory and it does not affect your transplant candidacy. And current clinical studies do vary from time to time of what is available.

Natasha Perez: Your evaluation will begin the day you come to clinic and be seen by the team. The goal is to get through this evaluation process in as little as 90 days. Everyone will get the standard testing of blood work, chest X-ray, some will need CTS of the abdomen. We do require some form of cardiac testing whether that is an EKG, echo or stress test. If anything does come back abnormal, we will ask you to seek other consultations for clearance.

Natasha Perez: We do ask that everyone maintain their health screenings such as cancer screenings. These include your pap smears, mammograms and colonoscopies. Sometimes we will ask for dental clearance. Other times your insurance does require this as part of the transplant evaluation.

Natasha Perez: And lastly, we do ask for you to stay up-to-date on your vaccinations. As part of your transplant evaluation, we will check to see if you have any immunity to hepatitis B. This is part of your evaluation. And we will ask that you complete the series of 3 vaccinations over a 6-month period of time. You may require boosters to help keep this immunity up. And this just serves as protection for you. Once you're in the post-transplant phase we do lower your immune system. So any vaccinations do benefit you to help protect you. If you are a dialysis patient, you may already have completed this series of vaccinations. If you're not on dialysis, you may need to seek out to your primary care provider to see about getting all these immunizations up to date. We also recommend all the other vaccinations per your age or medical and conditions. We do think that the flu is a yearly vaccination, the pneumonia is about every 5 years, tetanus every 10 and shingles for those over the age of 50, which that 1 we do require you to only do prior to transplant because it is a live vaccine. We are recommending the COVID-19 vaccine if it is accessible to you. Once again, after transplant, you are not allowed to receive live vaccines anymore. And that is because you are immunosuppressed. These are examples such as shingles, the yellow fever or the flu mist. Not the flu shot, the nasal mist.

Natasha Perez: So after your transplant evaluation when you come to clinic, we'll give you an After Visit Summary. This is just a summary of your clinic visit. It will also have a rough draft list of the items we know and expect for you to be able to complete in order to get on the wait list. If you're a new patient to us, all new patients will be presented in the selection committee the following Wednesday. In the meantime, you can always contact your primary care provider and make sure you are being scheduled and set up to update all of your cancer screenings and immunizations. Always stay in contact with our transplant coordinator to ensure that they know you are completing your testing and so we can obtain those records for quicker listings. A tip is to just sign up for MyChart. This does give you access to all of your testing results and it aids in a quick communication between your transplant team.

Natasha Perez: So what is selection committee? Selection committee is a meeting that is held every Wednesday and you do not attend it. This is only for the staff to discuss new patients and patients that are ready for approval. So everyone you meet with during your transplant evaluation day, they attend this selection committee and put in their 2 cents about how you were as a candidate. There are 3 decisions that can come from this committee and that is approved, deferred or denied. If you are approved, that means you've completed all your testing and you're ready to be put on the wait list. If you're deferred, that means maybe you need to complete some more testing such as your echo and stress test. And if you're denied, that just means we found something that could be potential barrier to transplant, and your nurse will guide you on next steps after that.

Natasha Perez: So some things you have to meet in order to get approved here at our transplant center is that you need to have advanced kidney disease. That's either being on dialysis or having a GFR less than or equal to 20. You need to be suitable medically and surgically. You need the financial resources to cover your transplant and the immunosuppression after. We do require social support, and that is just because you're going to need some assistance after transplant getting to and from the hospital and to just picking up medications and things like that. Also, we need to have all the testing completed in order to proceed. And then we also want to make sure that you're able to follow medical recommendations. This is very strongly recommended because after transplant, you'll get your labs drawn potentially 2 times a week, and we will just call you after and change your medications over the phone. So we want to make sure you can follow recommendations now, so you can follow those easy steps after transplant as well, and be successful.

Natasha Perez: Some things we take in consideration for being approved during selection committee. You do need to meet the following criteria. You have to have advanced kidney disease by either being on dialysis or have a GFR less than equal to 20. You do need to be a medical and surgical candidate. You do need the financial resources to be able to afford your post-transplant care and immunosuppression medication. We would like you to have social support to be able to help you and assist you during that post-transplant time and getting you to and from your appointments. We also need you to complete all of your testing and have those results back. Lastly, we would like you to follow medical recommendations and treatment options now, that gives us guidance to how you'll be able to follow your medical recommendation and changes of immunosuppression after posts transplant, getting listed with UNOS. You can get listed once the committee has approved you.

Natasha Perez: Next, you may need a listing authorization through your insurance company. And this solely depends on which insurance company you have. It's just a long number that tells us, yes they will pay for your transplant. You may also need to update your MTN sample which means you just have to send, get your blood drawn and send it into MTN. While you're active on the wait list, you will need to send that in once a month. If you're on dialysis, your dialysis center will do this for you like clockwork. If you're not on dialysis, then your nurse will send you a kit in the mail and you'll go to an outpatient lab and have that drawn and then drop it in a FedEx box. It does come with a prepaid postage on that mailer, so there's no worry for that.

Natasha Perez: Next, we'll talk about your wait time. Once you're listed your wait time begins. Wait time does depend on many variables. Part of that is your blood type, your antibody level and organ availability or donor availability. If you are on dialysis when we list you, you would get credit for that dialysis time. So if you've been on dialysis for 2 years and we were to list you today, you would get that credit for 2 years and have 2 years of wait time under your belt. If you are not on dialysis, the day we list you start to time clock and then it just builds from there. The wait list is always changing. People are added and removed all the time. So we cannot tell you exactly where you are on the wait list. The list is only ran when a donor becomes available and the list is ran per that blood type. Once listed, we'll just need to see you once a year and update your testing as necessary. If you're over the age of 70, we would like to see you every 6 months. And it's very important to keep your coordinator up-to-date on anything that changes throughout the year, such as insurance information, health changes, the start of dialysis, any hospitalizations. Also a big important 1 is phone numbers and emergency contacts. We cannot contact you with an organ offer if your phone number changed and you did not let us know. So make sure we have good emergency contacts as well to get a hold of.

Natasha Perez: Next, we'll talk about KDPI or Kidney Donor Profile Index. This is a score that is generated off of the donor's health history. We do have to protect the donor's HIPAA rights, so we can't share a lot of information with you. And this score is built off of their medical information. It also predicts off of that medical information how long that kidney is predicted to last. It is not an exact science, it's just a rough estimate to give you a good guidance of how well that kidney is going to last after transplant. The score does range from 0 to 100%. The lower the score, the longer the kidneys is likely to last. And that is because this is a comparative score. So what it does is it takes this one isolated kidney and it compares it to all the other kidneys procured in the previous year. So it takes this one kidney, and if that score is 20%, that means it will outlast 80% of all the other kidneys procured in the previous year. So if we go to the other end of the spectrum with the KDPIs that are greater 85%, if you put it into that same scenario, these kidneys will only outlast 15% of the other kidneys procured in the previous year. That does not sound fantastic, but these are still good kidneys. And we do biopsy every single one to ensure the quality prior to transplant. If we do decline the organ, that does not mean the kidney does not get transplanted. They do go to other centers with longer wait times and they do transplant them and save people's lives and get them off of dialysis. These kidneys currently right now are approximately lasting about 5 to 7 years after transplant and we have deemed certain patients to be good candidates to receive these organs. We will give you a handout when you come for your transplant evaluation, that does guide you. Some of those things are, am I over the age of 65? Do I have diabetes? Maybe I don't have any wait time, so it's best for me to try to get a transplant sooner? The choice is always yours. This is your health and your decision. It does not affect your transplant candidacy on how you choose. If you choose to say "yes, I will go ahead and accept greater than 85% kidneys," that means when we list you for transplant you will receive all organ offers 0 to 100% and you get to make the decision at the time of organ offer. If you say, "no, I don't even want to be bothered with these," that means we'll list you to only receive 0 to 85%. And once again, you can accept and decline any organ offer that comes to you, no matter what the KDPI score is and it does not affect your transplant candidacy. You do not go to the bottom of the list or anything. You will just get the next organ offer to you.

Natasha Perez: Now, we're going to talk about your score as the person receiving a kidney transplant. This is called EPTS or the Estimated Post Transplant Survival score. The score also ranges from 0 to 100%. It's based off of 4 factors, your age, your number of previous transplants, your time on dialysis and if you have diabetes. If your score rank is 20% or less, you will get additional points on the wait-list towards kidneys with KDPI scores of 20% or less over others even with more dialysis time. UNOS changed this to try to match younger candidates with longer lasting kidneys. We know young candidates are going to need more than 1 transplant in their lifetime. And so we want to give them a nice long lasting kidney the first time, since it will be harder to transplant them a second time. If you'd like to check your EPTS score, just open the search engine, type in EPTS calculator, put in your information and it'll generate a score. And don't worry if your score is above 20%, there are ways to get kidneys with KDPI scores of 20% or less even without having that EPTS score. And we'll get into that further.

Natasha Perez: And now we'll talk about blood types. There are 4 blood types out there. There's O, A, B and AB. AB typically gets transplanted the quickest because it can receive from all blood types. O is very limited and will wait one of the longest periods of time for a transplant, because it can only receive from O. A is a very common blood type and gets typically transplanted between the 2 and 2½ year mark. B is limited because it can only receive from B and O and it's not as common. So with A being a common blood type, they did find that it can be actually sub typed into 2 different blood types. It can either just be plain A, or it can be a rare form of A, which is called A-2. And they found that this A-2 blood type acts like O and can be given to all blood types. What this does is it opens up an extra organ group too for Os and Bs to receive from. So we would do on the back end some additional testing to ensure that you would be a candidate to receive these, but it is just a benefit to help you get transplanted sooner if you're an O or a B.

Natasha Perez: So getting an organ offer call. We do call from unknown and blocked numbers. So please don't have that feature blocked on your phone. It is time sensitive. We do have to get ahold of you within an hour. That does not mean you need to be into the hospital within an hour, we just need to know if you're willing to move forward with the organ offer if you're interested. Several hours will pass after that because we're doing a lot of testing on the backend to ensure it would be a safe transplant. We would work on cross-matching which takes about 6 to 8 hours. And we do do this in group batches. So with every donor, there are 2 kidneys. So we'll need a primary person for the organ and a backup person for the organ, for each kidney. Instead of doing this individually, we will run this in a batch because if someone does not pass their cross-match we don't want to wait another 8 hours to cross-match another group of people. So we'll do it in groups. So we will let you know if you are the primary person for the organ, or if you're a backup person. We do typically call you into the hospital before the donor's even gone to the OR to have their organs removed. So there is a chance you could be sitting in the hospital waiting for your transplant, and it is canceled. It is unfortunate, but sometimes when the donor is taken to the OR things are found within surgery and if it is not safe to transplant, then we would cancel it.

Natasha Perez: So how does this process work? What happens is a patient will come into the hospital, and the hospital may notice that that patient does not look like they're going to have good outcomes. They will contact MTN, and MTN will come to the bedside and evaluate the donor and speak with the donor's family. If that donor becomes a candidate, they would contact UNOS to let them know that we have a donor available. UNOS will run the wait list for that donor of that blood type. If 1 of our candidates is on the wait list, we would be then contacted and then contact you to see if you're interested in that kidney.

Natasha Perez: So we've talked about cross matches. What are cross matches? This is where that sample that you've turned in every month has just been sitting in a fridge and we will pull it out when you are being called for an organ offer. We'll pull it out of the fridge and we'll physically mix it with the donor's blood to see if your antibodies in your blood will attack the donors blood. We already know you're a blood type match, so we are just looking at an antibody level if you will safely be able to be transplanted with this organ. If there is no reaction by this cross-match, then it is okay to proceed. And like we said before, it does take about 6 to 8 hours to run these tests.

Natasha Perez: We mentioned antibodies in the cross-match. What are antibodies? This is your immune system's response to anything foreign that enters your body. So if we let you know that you have an antibody level or a PRA, which is a panel-reaction antibody, that means you had possibly had some type of exposures in your past to something foreign that has made your immune system hold on to antibodies. What this means for you is you could possibly not pass every cross-match or cross-match with a donor that comes to you. So how do you build these up? Things that you could be exposed to that could make your immune system be reactive are blood transfusions, pregnancies, previous transplants and even immunizations. Some of these you hold on for long-term and some are only temporary. That is why we have you send in a monthly antibody sample, so we can compare them to ensure if it's only temporary or long-term.

Natasha Perez: Next we're going to get into type of organ offers that you can be offered. We have brain death candidates, cardiac death candidates, en block candidates and donors with risk such as hepatitis B, C and HIV donors. So the first donor is a donation after brain death. This is what we consider a standard donor. These donors have had some type of tragic event that has happened, and it has sustained injury to their brain. A physician has declared them brain dead and they do have a date and time of death. They are still supported in an ICU on life support. And when all of the organs are placed, they will be taken to the OR and have their organs removed and sent to the recipients. Important part of this information is, because there's already a date and time of death, their blood flow does flow all the way to the time of removal, which gives you a best outcomes for transplant.

Natasha Perez: Our next donor is called donation after cardiac death, also known as DCD. This donor has had a tragic event happen, but has not sustained enough injury to be declared brain dead. These are irreversible changes and family is choosing to withdraw care. They may make the patient comfort measures only. They are still in an ICU and family is going to choose to withdraw that life support. The difference in this patient is, they do not have a date and time of death. They do have to have their heart slow to a stop. So what will happen is if they're going to be a donor, is we will take them to the or and remove their life support. The donor does need to pass away within 60 to 90 minutes for us to successfully and safely use these organs which this means the heart is slowing to a stop. With that blood supply is also slowing to a stop to all the organs. What this means to you as a person receiving these organs is you could possibly have delayed graft function. What this means is those organs think they are passing away but then we transplant them and put them in you and they're receiving blood flow again. This could mean that the kidney is sleepy or needs time to wake up and realize it needs to start filtering your blood again. For the in-patient stay, you may notice that you may have to stay on your renal diet longer. You may need a dialysis session or two, but it just needs time to wake up and start functioning again.

Natasha Perez: The next type of organ offer is our en block kidneys. These donors are small children or infants. Instead of receiving one kidney from them, you'll be receiving both of their kidneys. This surgery is still the same. The kidneys will be placed on 1 side of your hip. So you'll have 2 small kidneys down on 1 side of your hip. With this, there are multiple hookups because you're receiving 2 kidneys you'll have 2 arteries, 2 veins and 2 ureters. Due to the multiple hookups these are at increased risk for clotting and increased risk for urinary leaks because of the multiple hookups, but they are pediatric kidneys and they're nice long-lasting organs. Also with this, the KDPI score gets skewed because body mass index is one of the factors that plays into populating that KDPI score. Because this is a small child the BMI is different from that of an adult which makes the score falsely high. The score tends to be typically above 85% but we do know these are pediatric kidneys, they're long lasting. So the score is falsely high. So just take that into consideration when being offered these organs.

Natasha Perez: Our next donor are donors with risk criteria. So all of our donors are screened for infectious disease and it's very accurate screening. But there is a chance that if the donor had participated in an high risk activity close to the death, then the viral detection would be negative when it could possibly be positive. The risk of missing this viral detection is very low, it's 1 in 10,000. We will draw labs when you come in to the hospital for with every admission. And if you receive a donor with a risk criteria, we'll also monitor your post-transplant with additional labs. We do have to let you know if a donor did participate in a high risk activity, and those are declared by the Public Health and Safety Services. Such activities could be an IV drug user, someone who sells sex for money, male to male contact, hemodilution, someone who needed a lot of blood product because they were in a bad car accident. Things of that sort. We do let you know, as informed consent that these donors did participate in these activities, and it is your right to accept or decline these organs. Once again, it does not affect your transplant candidacy and it will not put you to the bottom of the list. But remember sometimes when we call with these organ offers, younger people are who are participating in these risky behaviors. So the KDPI on them could be 4%.

Natasha Perez: Our next organ offer is the hepatitis B and C exposed donor. You could potentially receive these organ offers in the future, so we'll go over those details. So if you get a call with a hepatitis B core positive donor, that means that donor was exposed to hepatitis B in the past, but does not have an active infection. If you have your hepatitis B vaccinations, you hold immunity and could be safely transplanted with a hepatitis B core positive donor and not obtain hepatitis B. You could also be offered a hepatitis B or C antigen-positive donor. That means that patient has an active infection of hepatitis B or C, and now hepatitis B and C is treatable. So if you were to get transplanted with one of those organs, you would obtain hepatitis B or C and then go through the treatment process after.

Natasha Perez: Next are HIV exposed donors. These are reserved for our patients who have HIV. We want to give them all possibilities of organ transplantation, but these are only reserved for our HIV positive recipients. Once you receive your transplant, anticipate to stay in the hospital for 3 to 5 days after transplant. You're going to have all the things you love while in the hospital, hospital food, you're going to have IV fluids, medications. You'll also have an in-patient nurse coordinator. They will come and teach you everything you need to know about how to take care of your new kidney transplant. They will also give you a posttransplant binder that has even more information to help you guide you through your new post-transplant phase. We will also educate you about your ureteral stent that has been placed.

Natasha Perez: So when we take the donor's kidney, we also take their ureter and we will attach their ureter to your bladder. This is a tiny tube, and we want it to remain open. So we're going to put a stent in there to hold it open so urine can drain freely into the bladder. This will remain in there for 4 to 6 weeks after transplant and then it will be removed in an out-patient setting by urology. There is no anesthesia involved in this process. It will be uncomfortable for about 5 minutes but it will be removed. After you go home, if you live more than an hour away from the hospital, we do ask for you to stay locally for 2 weeks. And if you required plane travel for your transplant we will ask you to stay locally for 8 weeks. During this timeframe you will be seen in our clinic 2 times a week for the first 2 weeks. One will be just for a lab appointment the other will be for labs and a visit with the transplant nephrologist. Even after those first 2 weeks you will be getting labs weekly for weeks to months but those can be done closer to home. You'll also be monitoring your blood pressure, your weight, your temperature, and your urine output. And you will be collecting that data and bringing it to all of your transplant appointments. So your transplant nephrologist can evaluate how well your kidney transplant is doing.

Natasha Perez: So what are we looking for with labs? We're looking for rejection and what is rejection? It's the natural response to anything foreign put in your body, and this is from your immune system. It's most likely to happen in the first three months but it can happen anytime after transplant. It's highly linked to how often you get your labs drawn and how often you're seen in clinic. You do need to take your medication forever. This is for life. Your body will never like something that is not yours. So we will constantly be monitoring you and keeping in touch to ensure your transplant stays safe. Your immunosuppression or anti-rejection medication does come with side effects. You'll have increased risk for infection because we've lowered your immune system. You are at increased risk for cancer. The most common type of cancer after transplant is skin cancer. So we do recommend that you establish with a dermatologist now and start your annual skin checks. Also it can impair kidney function. So if your immunosuppression medication is too low, you would reject your kidney, if it is too high it could possibly harm the kidney function. So that's why we do frequent labs to ensure we have the right level of immunosuppression for your body. Also for our women it does cause birth defects. So we do ask for you to work with your PCP or OB GYN to find some form of birth control that works for you. If that is something you wish for in the future, just be open with the transplant nephrologist so they can discuss those options.

Natasha Perez: Gift of Life is a benefit here that you can take advantage of if you would like to reach out to anyone who's gone through the transplant process here at The Health System. It is a free service and you just contact Andy Donnelly, the manager there at the Gift of Life, and they can set you up with someone who's been through a kidney transplant or a kidney pancreas transplant here at The Health System. Now these are just the general population. So they are not giving medical advice but this is just a benefit to help with any type of questions or emotional support. They also have individuals who've gone through the living donor process. They also have support people that go through that process. So whatever you're looking for for a mentor or just guidance, they have someone there to be able to put you in contact with. You can do this via phone, in-person or even email.

Natasha Perez: So when you come for your transplant evaluation, you'll meet with all the members of the transplant team. We'll also make sure all of your forms are up to date and get everything signed. We'll also do your lab work and possibly imaging. We'll give you that rough draft to-do list to make sure that you can get toward to that wait list or maintain your status on the wait list. After that, if you're a new candidate, we will take you to selection committee. If you are already on the wait list, then you'll just go to selection committee as needed and then complete and work on the items to maintain that status.

Natasha Perez: Now, we're going to go over the forms that you will see when you come for your transplant evaluation. The forms that we'll have you sign are your release of information, your ethnicity form, your education checklist and the pregnancy and transplant form or the mycophenolate acknowledgement.

Natasha Perez: So the first form is the release of information. We will ask you to sign and date the bottom of this form. What it allows is for us to obtain records that you've completed outside of The Health System.

Natasha Perez: The next form is the ethnicity form. We'll ask you to Mark all that apply to you in sign and date the bottom we use this in matching and for UNOS information. Next will be the education checklist. This is just an acknowledgement of information received.

Natasha Perez: So the first four that we ask you to initial on, says you received your transplant education and then you also received additional transplant information. You will receive those booklets of information during your transplant evaluation.

Natasha Perez: The next one says that we gave education over KDPI and EPTS scoring. So if you remember KDPI is the score of the kidney that you're offered and EPTS is your score as the patient receiving the organ. The next is the greater than 85% kidneys. There is also a yes, no below this. This is how we will list you for transplant in UNOS. So if you say yes, I would like to receive greater than 85% kidneys, That means you will be listed to receive all organ offers, zero to 100%. If you mark, no that means you only show up on zero to 85% organs.

Natasha Perez: The next one is the A2 kidneys. This states you received information about A2 kidneys and yes no below that is whether you'd like to receive them or not.

Natasha Perez: The next one section says, we gave information over hepatitis B, C, HIV and the donors with risk. This is not saying, you'll accept these organs, just saying you received education.

Natasha Perez: The next one is the SRTR data. This is the information that you can find on the srtr.com website about transplant outcomes at every transplant center across the United States, and you know where to access it. And if you need assistance, please just contact your transplant nurse coordinator.

Natasha Perez: The next one is acknowledgement saying that you know immunosuppression can cause birth defects. Also with that, it is absorbed quickly through the skin. So anyone who is pregnant or trying to become pregnant cannot even handle your immunosuppression medication. Lastly, we would just ask you to print, sign and initial the bottom of the form.

Natasha Perez: The last form that you may see is the mycophenolate. This is an immunosuppression that we'll put you on that causes birth defects. This is acknowledgement saying, yes I know not to become pregnant while on this medication. I will also advise those who are handling my medication that it does absorb through the skin very quickly and can cause the same birth defects just by handling it. So if you're pregnant or trying to become pregnant, please do not handle this medication. So we would ask you to print, sign and date the top of that form.

Natasha Perez: That concludes your pre-transplant education. If you have any questions please feel free to call our office or we'll see you during your transplant evaluation. Once again, thank you for attending this transplant education. We look forward to seeing you in the future.