Dialysis Services at Guthrie

Kidney (or renal) transplant is another possibility as a treatment option for people with end-stage renal disease (ESRD). A kidney transplant will give the ESRD patient the closest experience of a "normal lifestyle" without undergoing dialysis. A transplant is considered therapy for the ESRD patient and not a cure due to the possibility of rejection and the intense lifelong course of medications you will have to faithfully take everyday. Your doctor and supporting staff will help you determine if a transplant is the best treatment option for you. If so, your physician will refer you to the transplant center of your choice for further evaluation. A comprehensive medical evaluation (chest x-ray, EKG, bloodwork and possibly a heart catheterization) will be performed before you are placed on a waiting list or a living donor candidate is screened. Almost 79,000 people received functional renal transplants in 1996.

There are two sources of kidneys for transplant: Cadaverous (someone who has recently died but consented to be an organ donor) or a living donor (a person, related or not, who has decided to donate one of their functioning kidneys). Donor kidneys are tested for compatibility through tissue and blood typing before arrangements are made for transplantation. Not every kidney can be used for your transplant. The better the kidney match, the less likely you will reject the transplant. Breakthroughs in anti-rejection medication have shown they are effective in decreasing your risk of rejection and are associated with increased short term transplant survival.

To receive a cadaver kidney, you are placed on a computerized waiting list that takes into account the blood and tissue type of the patient and the available cadaver donor as well as the length of time you have been on the waiting list. The average waiting time for a cadaveric kidney is close to two years. While waiting for an available cadaveric kidney you may have to undergo some form of dialysis and will need to have regular blood work done. Most patients receive a pager so the transplant center can immediately contact them when a kidney becomes available.

Living donor kidney transplantation has some definite advantages. For instance, there is no waiting list for a living donor kidney. You and the donor must still undergo a full "work up" to determine compatibility. The U.S. Renal Data System has shown in research that living donor transplants tend to have a longer functional period than cadaver kidneys. The kidneys from a living donor also do not have the extended period of time between donor and recipient or the preservative measures that cadaver kidneys must undergo.

You will spend between 1-2 weeks in the hospital after you receive a transplant. The operation should last between 2 to 4 hours. Your kidney transplant should start working quickly but may take up to a few weeks, in which case you would continue with dialysis therapy until the kidney can function on its own. You will be surprised to know the transplanted kidney is placed in your lower abdomen while your other kidneys are left in place. The kidney is placed in the lower abdomen for easy access if complications were to develop.

Upon receiving a renal transplant you will increase your life expectancy and notice you are feeling better. This is due to the more efficient and effective reduction of waste products in your blood stream. You will begin to be able to eat a more normal diet and have less restriction on fluid intake. Your greatest responsibility lies on remembering to take your medications as scheduled, no matter how well you are feeling, and to attend your doctor’s appointments.

Both Medicare (Federal Insurance) and Medical Assistance (State Insurance) programs cover the cost of transplantation, provided the surgery is performed at a Medicare/Medical Assistance approved hospital. Each of these two insurers cover inpatient hospital services as well as preparatory lab work and follow-up work. Medicare and medical Assistance also will cover your surgeon’s services, as well as pre- or post-operative care.

Medicare will also cover the full cost of a kidney donor’s preparatory, operative and postoperative care. There is no deductible or co-insurance payments for the donor. The inpatient stay qualifies your donor for any other Medicare coverage not related to the kidney donation. All other deductibles and coinsurance payments remain the same for the kidney recipient. Beginning in 2000, Medicare will also extend its coverage of immunosuppressive drugs beyond the first three years of transplantation.

Medical Assistance coverage varies slightly depending on the state in which you reside. Medical Assistance will apply for almost all services needed, but each state sets the amount of monies that a doctor, hospital, or lab can expect to receive for each individual service. The bottom line for Medical Assistance patients is that they need to check with their transplant center social worker or billing office as to what costs Medical Assistance reimbursement covers for which the patient will be billed.

Some national and local organizations may also help patients offset the cost of transplantation. Therefore, it is unlikely that anyone would ever be refused a transplant for financial reasons.

Kidney transplants are not performed at Robert Packer Hospital. There are, however, several transplant centers to which our patients are referred. These transplant centers have excellent reputations. The decision of which transplant center to go to is usually left to the patient’s discretion. Travel time or familiarity with a city are sometimes important considerations.

At present, we have patients on transplant lists at the following institutions:

1. Albany Medical Center, Albany, New York

2. University of Syracuse Hospital, Syracuse, New York

3. Strong Memorial Hospital, Rochester, New York

4. Geisinger Medical Center, Danville, Pennsylvania

5. Allegheny General Hospital, Pittsburgh, Pennsylvania

6. Presbyterian University Hospital, Pittsburgh, Pennsylvania

7. Hospital University of Pennsylvania, Philadelphia, Pennsylvania

8. Thomas Jefferson, Philadelphia, Pennsylvania

9. Hershey Medical Center, Hershey, Pennsylvania

Other transplant centers have been able to assist our patients in the past. If you have questions about these or any other facility, please ask your physician.

Albany Medical Center

43 Scotland Avenue

Albany, New York 12205

518-445-5606

Transplant Coordinator: Frank Taft

Allegheny General Hospital

320 East North Avenue

Pittsburgh, Pennsylvania 15212

412-359-6258

Transplant Coordinator: Mary Ann Palumbi or Andy Paul

Geisinger Medical Center

Danville, Pennsylvania 17821

570-271-6214

Transplant Coordinator: Ruth Latsha

Presbyterian University Hospital

DeSota at O’Hara Street

Pittsburgh, Pennsylvania 15213-2582

412-648-3200

Transplant Coordinator: Mark Paynton

Strong Memorial Hospital

601 Elmwood Avenue

Rochester, New York 14642

716-275-7753

Transplant Coordinator: Barb Beyer

SUNY Health Science Center

750 East Adams Street

Syracuse, New York 13210

315-464-5540

Transplant Coordinator: John Henry

Thomas Jefferson University Hospital

Hospital of the University of Pennsylvania

Tissue Typing Lab

7 Founders Pavilion

3400 spruce Street

Philadelphia, Pennsylvania 19104

Hershey Medical Center

Mail Code H140

PO Box 850

Hershey, PA 17033

(717) 531-8521