A TRANSPLANT SURGEONS PERSPECTIVE

The transplant phone call: what to expect

Deciding to go on the kidney transplant list is a life-changing step. The next challenge? No one can say when the call will come. Here’s what to expect when it does.

By Jeremy Crane 

It is not easy being on the waiting list for a kidney transplant. However, in some ways, it is a positive step. Being on the list means your local transplant surgeon and physician feel you would benefit from having a transplant. So, when my patients tell me they are ‘putting their life on hold’ whilst they wait for the call, I don’t feel it is the best way forward, particularly from a mental health perspective. 

It is very difficult to say when you are going to get that all-important call to tell you a transplant is available. The statistics from NHS Blood and Transplant (NHSBT) reveal the average wait times are 2 to 3 years. The time spent waiting is valuable years of life. Some people get the call in a much shorter time, some wait many years. There are lots of reasons why waiting times differ so much. In general, those that don’t wait as long often have a common blood group (eg AB) and tissue-type, and fewer antibodies in their blood. Children and young people under the age of 18 tend to wait less than adults. Those waiting from a Black, Asian and minority ethnic background tend to wait longer. Also, there is waiting time variation between UK transplant units. 

Keep your phone turned on!

Once you are on the list, the most important point to make is that your phone should always be on. The call can come at any time, so it is vital you are contactable day and night. Make sure your local unit has your mobile and home phone number, also a number for your next of kin. 

When the call comes, it can be at any time - night or day. It generally means that you are considered to be the best match on the waiting list for that particular kidney at that time.  The call is made by a member of the transplant on-call team. You will be asked if there are any new major medical issues that your local centre might not know about. If there isn’t, you will be asked to come to the transplant unit as soon as you’re able. In some circumstances, the urgency is a little less with quite some time (12 to 24 hours) before the transplant takes place. But sometimes time really is of the essence and the transplant might take place within a few hours. 

Occasionally the phone call might be a conversation about your willingness to accept a certain transplant, for example, if the kidney is deemed not to be ideal, This will be a conversation with the transplant professional who will give you all the information you need. Certain characteristics about the donor can be shared with you, including the age range (decade), male or female, type of death and whether the donor had any illnesses or diseases that might affect the long-term outcome of the transplant.  

Don’t panic

After the phone call, stay focused on arriving at the hospital safely. In your overnight bag, pack some essentials, and include a phone charger, nightclothes, underwear, slippers, toiletries and other necessities. Bring all your current medication and don’t eat or drink anything. 

Once you arrive there will be lots of blood tests, x-rays and often, a fair bit of waiting around. One important blood test is a ‘cross match’ between yours and the donor’s blood - if there is no cross-reactivity, it is deemed negative. We typically expect it to be negative, but occasionally if there are immunological issues, it might be positive (although this does not happen often). The anaesthetist will also see you. It is not uncommon for the transplant to not work out. The most common reason is due to the donor being from a ‘donation after circulatory death’, where the retrieval of the organs does not always take place. The transplant surgeon will keep you in the loop. 

Once the kidney arrives in the transplant unit, the transplant surgeon will ‘bench’ the kidney. This benchwork involves reconstructing the blood supply of the kidney, removing all the fat and other tissue from it, and making sure there is no damage and it is in good shape to be transplanted. If there are significant issues with the kidney at benching, the surgeon will discuss these with you. At this point, your surgeon will go through a consent process to make sure that you are willing to move forward with the operation and you understand the risks and complications involved. We hope that this wouldn’t be the first time you’ve heard about these, and they would have been discussed with you in your clinic appointments. Once all the above has happened, and a theatre slot is available (sometimes this might not be the case and there can be a delay whilst other more urgent operations finish), you will be wheeled down to theatre.  

Jeremy Crane MD FRCS (vasc)

Consultant transplant and vascular surgeon at the Hammersmith Hospital West London

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