What is the process to be selected for wait list?
To be active on the transplant wait list, the recipient must go through the pre-transplant testing and be free from any of the contraindications to transplants mentioned above.
The pre-transplant testing will include the following:
- Blood group1 and HLA typing and cross match2
- PRA screening3
- Testing for blood borne infections such as hepatitis and HIV
- Blood work to assess kidneys, heart, liver, etc.
- Chest X Ray
- Abdominal ultrasound
- Thorough cardiac (heart) assessment
There are other tests that could be ordered based on the individual cases
1. Blood group matching
- Testing for the blood type of the recipient and the kidney is done to establish compatibility.
- The transplant center does not perform incompatible blood group transplants
- If the donor and recipient are not matching, the transplant will not be done, and the kidney will be allocated to another matching patient, and the recipient will remain on the transplant wait list.
2. HLA Tissue typing and crossmatch
- Human Leukocyte Antigen (HLA) is a type of protein marker found on cells in the human body. These are unique to every person, except identical twins. The human body uses these cells to identify which ones belong to the body and which do not.
- The closer the match of HLA markers between donor and recipient, the better the outcomes of the transplant. But it is possible to have mismatches and still transplant under certain conditions.
- The crossmatch is a very important test that identifies if the recipient's body will react to the donor's tissue. In this test, the donor's blood sample is mixed with sample from the recipient. If the recipient's blood has antibodies (proteins produced in the blood in response to a foreign cell or antigen; antibodies destroy antigens) to the donor's sample, it means the crossmatch is positive.
- A positive crossmatch indicates that the recipient's body will attack and destroy the donor's kidney. In such a case, the transplant cannot take place, and the search for another donor must resume.
3. PRA Screening
- Panel of reactive antibodies (PRA) screening is a test in which the level of antibodies in the system is measured and is used to calculate a percentage (%) estimate of donors who the body will reject.
- The PRA can range from 0% to 99%. A PRA can be high because of previous blood transfusions, pregnancy, illness or other reasons that increase the system's antibody levels.
- If the PRA is high, it means that it may take longer to find a donor kidney as the body is more likely to reject most donated kidneys. For this reason, patients with high PRA values receive high level priority during kidney allocation.
- While on the transplant wait list, a PRA screening is done at regular intervals to detect increased sensitivity. Typically it is done every 3 months, and repeated after a blood transfusion.