This is an information booklet for patients with
terminal kidney failure who have opted for kidney transplantation from a cadaver organ
donor. This will provide you with answers to questions you may have about the Human Organ
Preservation Effort (HOPE) and the transplant programs. It will enlighten you on several
aspects of cadaver kidney transplantation- registering in the waiting list, complying with
requirements and what to expect during and after transplantation
A Primer for
Prospective Cadaver Kidney Transplant Recipients
organ donors are usually victims of strokes, head injuries or accidents and have been
diagnosed as "brain dead". They are comatose, artificially kept alive by a
respirator, unresponsive to pain or stimuli and have total absence of brain function.
Their condition is irreversible and brain damage is permanent. They are DEAD although the
heart may still be beating.
Brain death cases are referred to the National Kidney and
Transplant Institute for potential organ donation by various private and government
hospitals.Brain dead patients are ideal organ donors since the functions of transplantable
organs can be temporarily maintained to keep them viable. The Transplant Staff of the NKTI
will explain to the relatives of these patients the concept of organ donation to help
numerous patients awaiting transplantation and a chance to return to a more normal life.
Patients requiring a cadaver organ donor have no suitable
living related donor. In a living donor transplant, the work-up and transplant operation
can be expeditiously scheduled to suit both recipient and donor. The patient and his donor
are well prepared for the procedures, physically, emotionally and financially. The
probablility of getting goood compatibility between recipient and donor is higher among
blood relatives. This does not mean, however, that a dacaver donor, being totally
unrelated to the recipient, will present a poor match. There is a fair chance for the
patient to get a good match even with cadaver donors. With the current advances in
immunosuppression, a "perfect match" is now considered not essential for a
In a dacaver kidney transplantation, we cannot predict when a suitable
donor will be available for the patient. The waiting time is indefinite so that the
patient will have to be maintained by expensive dialysis treatment and must always be
prepared for the unexpected donation. Cadaver kidneys are retrieved earlier from the donor
and preserved in a special ice-cold solution until they are transplanted. However, the
longer they stay in preservation, the greater is the possibility that the quality of the
kidney will be affected. In our experience, it is best to transplant them within 36 hours.
In some cases though, this can be extended to about 50 hours. The earlier the kidney
transplanted, the better the kidney functions in the recipient and the patient experiences
This is why the Transplant Unit requires patients to comply with certain
measures to facilitate immediate transplantation when a donor is available. The patient
and his family are advised to visit the HOPE office to dicuss these measures. The
requirements for cadaver organ donor pool enrollees are as follows:
1) Submit the following information:
a) Patients Name, age, sex, civil status, occupation, complete
address (Metro Manila and Provincial), Telephone number(s).
b) Two neighbors telephone numbers and names. (Note, that these
neighbors have to be informed beforehand that there is the possibility that they you will
be contacted through them)
c) Two relatives telephone numbers and names.
d) Office address and telephone number.
e) Local barangay or Police Department and telephone numbers.
f) Date when dialysis started, present type and schedule of dialysis.
g) Patient classification (Private or Service), Attending Physician and
We will need all this information so that the patient can be contacted
immediately for possible transplant. Kindly request your neighbors or relatives to inform
you right away whenever we call for you. Our call may come anytime of the day or night.
You must also be aware of the current estimate of expenses for the
transplant operation. Aside from the hospital and operation expenses on the recipient, the
total bill will include charges from the time of donor consent, i.e. medicines, laboratory
examinations, other diagnostic procedures, funeral arrangement, etc. The patient must
discuss these details with our financial counselor.
2) Clinical Abstract from Attending Physician; Recipient Checklist to be
The clinical abstract from your attending physician will give us a
history of your condition and present to us any current complications. The monthly
recipient checklist shall provide us with results of your recent laboratory examinations
and also reflect problems that you may have. These are necessary in order to evaluate
whether you are transplantable anytime there is an organ donor.
3) Blood Type and Complete Tissue Type (A, B, C, DR)
The complete tissue type is necessary to check your compatibility with
the donor. Tissue typing is a procedure that is done only once for a patient.
4) Monthly Submission of Blood (10 cc clotted sample) and at least two
weeks after a blood transfusion for storage at the Tissue Typing Laboratory. This is for
Tissue Crossmatching with potential donors.
Matching examinations with a cadaver donor also include tissue
crossmatching which is done every time a compatible donor is available. Monthly
submission of blood is absolutely necessary for compliance. The blood samples are viable
for one month so that all donors within one month from the date of submission may be
matched with you. Tissue crossmatching is done simultaneously for all waiting patients.
Thus, if your blood sample is not available or has exceeded its due date, you may not be
considered for tissue crossmatching with the donor.
A deposit is required to cover advanced payment of tissue crossmatching
charges and monthly storage fees. Service patients hsall secure a certification of agreed
counterpart from the Social Service Department before proceeding to the cashier to settle
the deposit. Patients shall obtain a Patient Deposit Control Booklet (PDCB) from
the Cashier as proof of payment of the deposit. Patients shall present the PDCB to the
Tissue Typing Laboratory Staff in order to qualify for monthly blood submission. If the
patient is not chosen for transplantation from a possible donor because of
incompatibility, the cost of tissue crossmatching shall be deducted from the deposit. The
patient shall update his deposit level to the original amount accordingly for use in
succeeding donors. Patients without deposits shall not be considered for tissue
crossmatching when a potential donor is available.
5) Contact Transplant Coordinator (+63-2-924-0680) for updates on the
patients condition, chage of address, inquiries, etc.
The HOPE staff must be contacted for any inquiries or problems that the
patient or his family may have. Kindly keep us posted on the patients whereabouts.
Please inform us whenever the patietn wishes to travel or transfer elsewhere than his
Immediate physical examination of patient for possible
transplant when a compatible donor is available
Whenever a possible donor is available, the HOPE staff will contact you
and instruct you to proceed to the NKTI immediately for physical examination and possible
transplant. when this happens, do not delay the trip to the hospital. This may happen at
the middle of the night or during weekends or holidays. Bring your personal things for
possible admission and do not eat or drink from that time. A physical examination is done
to ensure that you are fit for transplantation, i.e. there is no infection or
contraindication for a transplant. Depending on the medical evaluation, you may have to
undergo dialysis prior to transplantation.
You will not be allowed to eat or drink for about 12 hours before the
transplant. Several blood tests, x-rays and electrocardiogram will be done. Soap sud enema
is necessary to clean your bowels and you will be instructed to have a Phisohex shower
before the operation. It is also necessary that shaving of the abdominal and inguinal area
Intravenous fluids will have to be started as well as prophylactic
antibiotics. The anesthesiologist will be visiting you and pre-medications will be given
before you are brought to the operating room.
The transplant operation takes only about 3 to 4 hours. Your new
kidney will be implanted in the lower part of your abdomen, usually on the right side. It
may take a few days or a week for your kidney to become fully functional so that dialysis
may have to be instituted until the funciton of the new kidney is adequate. If it does not
function well immediately, it does not mean that it will not function satisfactorily in
Cadaver kidney transplantation may not give you the same length of time
to prepare as in a living-related donor transplant. Our aim is to transplant the kidney
into the patient at the soonest possible time.
We will call on you immediately when a possible donor becomes available.
News of the donor may come unexpectedly and you may feel anxious or unprepared. However,
you must always keep a strong and positive outlook. You have already decided that a kidney
transplant is the best treatment for you. This is the moment you have been waiting for and
NOW the chance is yours. Bear in mind the benefits that you will gain with a successful
transplantfreedom from dialysis, normal diet and activities, rehabilitation, and
most of all, a new lease on life.
The National Kidney and Transplant Institute (NKTI), a health agency
seeking total answer to diseases of the kidney and urinary tract
treatment and cure. The Institutes many faceted program brings help and hope to
millions of Filipinos who suffer from kidney and urinary tract disease, through research,
patients services, nationwide organ donor programs, professional education and public
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