Patients interested in kidney transplantation can schedule an appointment by calling our office at (212) 659-8086. The receptionist will forward your call to the referral coordinator, and your demographic, dialysis and insurance information will be taken. Once we have received clearance from your insurance carrier (usually within three to five business days), you will be called to schedule an appointment for an evaluation.

Outpatient Evaluation
An outpatient evaluation involves visiting our office where you will meet with several members of our transplant team. The requirements that you need to complete in order to secure a place on our waiting list that are not completed in our office that day will have to be completed after you leave our office.

If you do not live near Mount Sinai you can arrange to stay at the special residential facility nearby called the TLC (Transplant Living Center) the night before your appointment. You can request more information about this facility by calling TLC at (212) 348-3359.

The Initial Process
Beginning with the first appointment, you will undergo an extensive evaluation at Mount Sinai. The multidisciplinary kidney/pancreas team evaluating you includes nephrologists, cardiologists, transplant surgeons, social workers, transplant coordinators, and nutritionists. They will review your medical history, assess your physical conditon, and carry out a series of tests.

If you have potential living donors, we will also perform tests on the prospective donors to make sure he or she is a match.

On average, it usually takes patients approximately one to two months to complete their transplant evaluation. The length of time it takes is determined by how long it takes you to complete the necessary requirements and have them sent to us. Once the evaluation is completed your case is presented at our weekly candidate review meeting to determine if you are a suitable candidate for transplantation.

General Tests Include:

• History, including all operations, major hospitalizations, medications, results of major tests (e.g., cardiac evaluation, X-rays, scans, Dopplers)
• Chest X-ray
• EKG
• PPD
• Stress cardiac testing (e.g. Persantine-thallium, dobutamine ECHO)
• Social work evaluation
• Complete blood count, full chemistry panel, hepatitis studies, HIV screening, blood test for syphilis (VDRL), CMV, Herpes Simplex, and EBV titers
• Blood group typing, tissue typing, antibody screening, and cross-match test for patients who have living donor candidates
• Other relevant tests

For Women

• Gynecologic exam
• Pap smear
• Mammogram (if older than 40 years)

For Men

• PSA (if older than 55 years)

For Hepatitis C positive Patients

• Hepatology/ Gastroenterology consultation
• Hepatic Ultrasound
• Liver biopsy

Who Are Not Candidates for Kidney Transplantation?
Patients with the conditions listed below may not be considered for transplantation due to increased surgical or medical risk after transplantation:

• Current or recent history of cancer
• Untreated active or chronic infection
• Advanced heart, liver, or lung disease (Those patients might be considered for combined heart/kidney or liver/kidney transplantation.)
• Severe vascular disease
• sychiatric or psychosocial conditions which might interfere with your ability to understand or cooperate with your care

Once you have been approved for transplant, your name will be registered with the United Network for Organ Sharing (UNOS) national computer database.

While on the waiting list, your health status is followed by yearly or every other year appointments at The Mount Sinai Medical Center. Any hospitalizations, surgeries, blood transfusions, infections, or change in address and phone numbers are updated at this appointment. Similar blood tests and heart tests are also repeated.

Deceased donor kidneys are allocated based on blood type compatibility, antigen matching, and waiting time. On average, patients wait five to eight years for a kidney transplant, and three to four years for a kidney/pancreas transplant.

If you have a matching living donor candidate, they will undergo tests to ensure their medical suitability to donate. There are two main objectives when we evaluate a donor. One is to ensure their safety and well-being, and the other is to ensure that they are giving the recipient a good kidney. Once this has been determined and the recipient has completed their work-up requirements a transplant can be scheduled.

A living donor transplant is a scheduled procedure. You and your donor will have pre-admission testing and will be told what time to arrive the morning of surgery.

A deceased donor transplant is an unplanned or emergent procedure. You may receive a call at any time of the day or night from a transplant coordinator with instructions on where you need to go and when.

In both cases, you will need to spend three to five days at Mount Sinai for a kidney transplant, and 7 to 14 days for a kidney/pancreas transplant.

The transplant surgery usually takes two to four hours. An incision about 4 to 10 inches long will be made above the groin area on either the right or left side. You will have an intravenous line in your arm, which is used to administer fluids and medications the first few days after surgery. You will have a catheter in your bladder for the first several days, and the nurses will make sure that you are up and out of bed as soon as you can tolerate activity.

During your recovery at Mount Sinai, we will monitor you closely, prescribe and adjust immunosuppressive medications (medications to prevent rejection of your new organ), and reverse rejection if it begins. After discharge, you will require periodic follow-up. This is a crucial aspect of a successful transplant because this is how we will monitor you for signs and symptoms of rejection and infection and will make adjustments in your medication as needed. Medications often prescribed include Mycophenolate Mofetil, Prednisone and Cyclosporine or Prograf, and a variety of antibiotics. During the first few months, this drug regimen will be monitored by our team.

During your hospital stay, one of the transplant coordinators will instruct you on your discharge medications, dosage, and side effects, your activity limitations, and monitoring of your temperature, blood pressure, weight and urine output at home.

You will have your blood tests done twice a week first month along with once a week clinic visit. During the following two months, you will have blood tests done once a week and a clinic visit every other week.

After three months, you can go back to your referring physician for periodic follow-up, with input from our transplant team.

If you do not live near Mount Sinai, you may arrange to stay at the special residential facility nearby called the Transplant Living Center (TLC). You can request more information about this facility by calling the TLC at (212) 348-3359.

Donating a kidney is one of the greatest gifts we can give to a loved one.

Blood relatives, the spouse, or close friends of the kidney transplant recipients can be possible donors. Living donor transplantation is possible because we are born with two kidneys. After removal of one kidney, the remaining kidney takes over completely. Recent studies that examined the long-term effects of kidney donation have not demonstrated any increased risk of kidney disease or decreased lifespan compared to the general population.

The main advantage of living donation for recipients is that they do not have to wait for years on dialysis to receive a transplant. Many studies have shown better survival of kidneys transplanted from living donors.

Potential living donor candidates also undergo extensive medical and psychosocial evaluation before donation to ensure their safety and well-being.

Blood and tissue typing tests are the initial steps to decide the compatibility of the donor with the recipient. Subsequent testing of donors is necessary to show normal renal function and exclude health problems such as diabetes, hypertension, cancer, heart, liver disease, and infection.

A psychosocial evaluation is done to assess the donor's ability to understand all aspects and possible consequences regarding his or her decision to become a donor. The evaluation also should demonstrate that the potential donor’s decision was made without coercion of any kind.

The suitability of the blood vessels of your kidney for donation is determined with an MR or CT scan, which shows the kidneys, blood vessels, and ureters. This is performed in outpatient radiology as part of the evaluation procedure. Dye may be injected during the scan to help show the veins and arteries of each kidney.

The donor's medical expenses related to the evaluation, surgery, hospitalization, and immediate postoperative care are covered by the recipient's insurance company. If any problems arise in the future directly related to the kidney donor surgery, these are covered as well.

Living Donor Disqualifiers

• Younger than 18 years old
• Financial incentive
• High Blood Pressure
• Diabetes
• Active hepatitis B or C infection
• HIV
• Seriously overweight – can be considered a donor upon losing weight
• Active infection
• Kidney dysfunction
• Blood in the urine
• Kidney stones
• Solicited by advertisements or posted

Donors with a family history of kidney disease, such as polycystic kidney disease or Alport’s disease, or who have both parents with diabetes mellitus may be considered after specific studies are done.

Laparoscopic Kidney Removal
Currently, almost all living donor operations at Mount Sinai are performed laparoscopically, using a surgical telescope inserted through a very small incision. This technique significantly shortens the recovery time compared to the older technique of open flank incision. The donor is admitted to the hospital the morning of the surgery. Surgery is performed under general anesthesia.

Three or four small incisions are made in the abdominal wall. Under direct visualization through a surgical telescope, very narrow surgical instruments are used to dissect the kidney and remove it from its attachments. The kidney is extracted from the lower abdomen through a short incision about three inches long.

After the kidney is removed from the abdomen, it is chilled on ice, and prepared for immediate implantation into the recipient, who will already be anesthetized in a separate operating room.

The operation takes about two to three hours, with additional preparation time before for anesthesia and recovery time afterward. You will be allowed to drink a few hours after you wake up and will start light foods the next day. Abdominal surgery often slows normal bowel function, so return to a normal diet must be gradual. You may be able to go home the next day or the day after depending on how comfortable you are. You may able to return to work within 7-14 days.

It is common to experience discomfort in the neck or shoulders after laparoscopy. This usually disappears in about a day. Backache is also a common complaint and is due to the position on the operating table. This may last a week or more and is relieved with over-the-counter painkillers.

Donor Benefits and Risks
Laparoscopic kidney removal is a new-and-improved version of an established operation. You can expect much less pain, compared with open surgery. The risks of surgery are related to anesthesia, bleeding, and the potential for injury to the kidney or other organs during the procedure, which is rare. If at any time we encounter a problem that cannot be solved by laparoscopy, then a standard incision will be made and the procedure will be completed with open surgery techniques.

There is about a one percent chance of requiring a blood transfusion or a return to the operating room should bleeding occur after the surgery. In more than 500 surgeries performed at Mount Sinai since 1996, the incidence of complications requiring conversion to open surgery, reoperation, or bleeding that requires transfusion has remained at one percent without any death.

The Transplant Liaison is a professional healthcare position developed by Mount Sinai over two years ago to improve patient service and build strong relationships with community dialysis units.

The transplant liaisons travel to community dialysis units and provide on-site education on various aspects of transplantation and organ donation. For patients, most education takes place in small group settings. For staff, inservices are conducted and can be provided for nurses and other professional staff who require ongoing education certification. The liaison will also arrange for physician specialists from the transplant center to present topics on other aspects of transplantation, such as HIV-positive patients, research developments, and immunosuppressive protocols.

The transplant liaison helps to ensure continuity of care for any dialysis patient who is in the process of evaluation or awaiting transplantation at Mount Sinai by reviewing the dialysis records, visiting with patients, and meeting with the primary care team regarding the patient’s status.

Mount Sinai’s transplant liaisons are available to assist any patient or provider in the community regardless of institutional affiliation.

A Team of Experts
Pediatric kidney transplantation at Mount Sinai involves a coordinated, team-oriented approach of a diverse group of pediatric-focused health experts and staff. These individuals include nephrologists, transplant surgeons, transplant coordinators, cardiologists, infectious disease specialists, anesthesiologists, pathologists, radiologists, child life specialists, and social workers.

Individualized Care
Mount Sinai is always committed to providing individualized care to meet the needs of each patient. This is especially true when dealing with children undergoing organ transplantation. Each child is assessed by pediatric nephrologists, transplant surgeons, a transplant coordinator, and a social worker to provide a comprehensive, unified management plan specific to each individual child.

Families Included
Our comprehensive care encompasses the whole family. We are here to provide physical, emotional, social, educational and financial services that continue throughout the child’s life. We keep families well-informed and offer services to cope with the demands of transplantation and recovery. During the transplant, nephrologists, surgeons, and nurses share information with the family during daily medical evaluations of the child. When a pediatric patient is ready to leave the hospital, our transplant coordinator teaches the family how to care for their child at home, including intensive medication review.

The referring physician is always involved in the pre-transplantation process, as well as during the transplant, with the goal of returning the child to the referring physician’s care as soon as possible.

The Kidney/Pancreas Transplant Program at Mount Sinai began in 1967, making this center one of the first kidney transplant programs in the region.

As of 2006, we have performed more than 1,400 kidney transplants and more than 100 pancreas or combined kidney/pancreas transplants. As part of our commitment to enhance the quality of life for patients before and after transplant, surgeons at our hospital performed the first laparoscopic donor surgery in New York State in 1996, a procedure that dramatically reduces recovery time for individuals donating a kidney to a loved one. So far, more than 500 laparoscopic donor surgeries have been performed.