Southern California kidney transplant program
The transplant center at Riverside Community Hospital performs life-saving kidney transplants for patients in Riverside and Southern California. Our interdisciplinary team provides education, educational care and the very latest treatments for those receiving an organ transplant.
Our comprehensive approach to transplant includes supporting patients after their surgery through continued monitoring and follow-up care by key members of our transplant team, including nephrologists, surgeons, nurse coordinators, social workers and clinical pharmacists.
The transplant team at Riverside Community Hospital would like to thank you for your interest in our transplant program. We provide excellent, comprehensive care to our patients and look forward to working with you through the transplant process.
Call the RCH Transplant Center at (951) 684-1415 to schedule an appointment.
Physician required records
- Face sheet
- Copy of insurance cards
- A completed 2728 form
- Current history and physical
- Social worker evaluation
- Current labs
The financial impact of needing an organ transplant can be the source of much anxiety and concern for patients and families. The staff at the RCH Transplant Center understands the importance of considering the financial aspects, so we provide a specialized group of staff available to assist you in understanding and navigating this difficult but important part of your overall care.
Transplant financial coordinators are unique to organ transplant patients and provide education and counseling on all aspects of the transplant process from the financial perspective. They collaborate and communicate with the insurance companies and with the clinical and social services of the transplant team to provide a complete financial care plan for each individual patient.
Every potential transplant patient will have an opportunity to meet with a financial coordinator as part of the routine evaluation process for organ transplant. Your financial coordinator will remain an important member of your healthcare team throughout the transplant process, often working behind the scenes, but available to you on request at any time in the process.
The RCH Transplant Center also has dedicated social workers who have experience and training in organ transplant. One of their many responsibilities is to assist you in understanding the financial impact of your care. In particular, they will assist you with exploring your options to assist with prescription coverage after your transplant.
Frequently asked questions
An organ transplant is a very costly procedure. Most patients cannot afford a transplant without some type of health insurance coverage. The costs can be divided into two categories; medical costs and non-medical costs. It is important to look at both sets of costs in preparation for a transplant.
Medical costs include but are not limited to:
- Insurance deductible
- Insurance co-pay
- Prescription drugs and non-prescription drugs
- Evaluation and testing before transplant
- Transplant surgery
- Donor organ fees
- Care after the transplant
- Outpatient/clinic visits
- Laboratory testing
- Re-admissions to the hospital
- Physician fees including the transplant surgeon fee, anesthesiology fee, pathologist fee and radiologist fee
If you cannot get your prescription drugs after your transplant, your transplant will most likely fail. Just because you have health insurance does not necessarily mean you have coverage for prescription drugs.
Even if you have a prescription plan, it may not cover your drugs. This means you may have out of pocket expenses for your prescription drugs for life. This amount can be over $500 per month for the first few months and continue from $200 to $500 per month long term.
Medicare has significant limitations on coverage for drugs based on which plan you, the patient, enroll in. It is therefore extremely important that we help you explore what your prescription drug coverage is. If it is not enough to cover all of the medicines you will need, we will talk with you about the options available to get better coverage.
Some very low-income patients may be eligible for assistance from many of the manufacturers of drugs. Patients with no insurance coverage for drugs may also be able to get help with their prescriptions. The financial coordinator and social worker will speak with you in more detail about these options when they meet with you.
The financial coordinator will need to complete a thorough assessment of your financial circumstances. They will then be able to discuss how organ transplant will affect you financially. They will ask you some detailed questions.
- Your average annual income
- Other sources of income
- Your average monthly expenses
- Number of household dependents
- Type of insurance
- Prescription plan
- Employment or reason for disability
This is just some of the information that will allow us to do a complete assessment of how organ transplant may affect your financial situation.
The majority of insurance carriers, including Medicare and Medicaid, pay for organ transplant. If you have Medicare as your primary coverage, your transplant must be at a Medicare approved center. Riverside Community Hospital is a Medicare approved center for organ transplant.
The following web sites will have more information for you. In addition, the RCH transplant team will provide you with additional reading material on your first visit with us.
- Living Donation California
- National Kidney Registry
Our kidney care
Our nephrologists specialize in diagnosing and treating kidney disease. Other health professionals who treat kidney problems include primary care physicians, pediatricians, transplant specialists and urologists.
What causes problems with the kidneys?
Problems with the kidneys may include conditions such as kidney failure, kidney stones and kidney cancer. These problems with the kidneys may be caused by the following:
- Aging—As we age, changes in the structure of the kidneys can cause them to lose some ability to remove wastes from the blood, and the muscles in the ureters, bladder and urethra tend to lose some of their strength. However, this alone does not cause chronic kidney diseases.
- Illness or injury—Damage to the kidneys caused by illness or an injury can also prevent them from filtering the blood completely or block the passage of urine.
- Toxicity—The kidneys may be damaged by substances such as certain medications, a buildup of some substances in the body, or toxic substances, such as poisons.
Kidney and urogenital diseases
Diseases of the kidney and urinary tract remain a major cause of illness and death in the U.S. The National Kidney Foundation states that more than 26 million Americans are affected by kidney and urologic diseases, and millions more are at risk.
What are the symptoms of kidney disease?
The following are the most common symptoms of kidney disease. However, each individual may experience symptoms differently. Symptoms may include:
- Frequent headaches
- Itchiness all over the body
- Blood in the urine
- Loss of appetite
- Nausea and/or vomiting
- Puffiness around eyes and/or swelling of hands and feet
- Skin may darken
- Muscle cramps or pain in small of back just below the ribs (not aggravated by movement)
- High blood pressure
The symptoms of a kidney disease may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
Kidney transplant match
All humans have a built-in defense system that allows the body to protect itself against disease. Unfortunately, this defense system cannot always distinguish between what is good and what is bad for us. This can cause the body to reject the transplanted kidney.
Generally speaking, the best matches come from close relatives since they are most likely to share genetic characteristics which reduce the chances for rejection.
Typically, a biological parent, brother, sister or child of the candidate will make a better match. Other relatives, such as aunts, uncles or cousins, may be an acceptable match. Non-relatives, such as a spouse or friend, may be a compatible match, too. It is important to note that even poorly matched kidneys from living donors have better 10-year graft survival rates than closely matched or mismatched deceased donor kidneys.
Kidney donation and paired exchange
About one in every three donors does not match their intended recipient. In the past, that would mean the patient would have to wait for several years on dialysis until a deceased donor became available. Our living donor program offers an innovative option of donor exchange. We can facilitate a high quality living donor transplant by exchanging live kidneys between other incompatible pairs.
Kidney transplant surgery
Our laparoscopic procedure involves a few small incisions in a pattern around a larger central incision. The surgeon uses a small camera inserted through one of the incisions to guide the surgery, which removes the kidney to be used for transplant through the central incision. This opening is typically about one-third the size of the incision needed for removing the kidney in traditional surgery.
If traditional "open" surgery for kidney removal is required, the surgeon will make an eight to 12 inch incision in the lower side and back on the side where the kidney is to be removed. The surgeon must cut through muscles in the side and back to get access to the kidney. On rare occasions, a part or all of the lowest rib must be removed.
The transplant surgeon will spend some time reviewing the different surgery procedures with you, along with the advantages and disadvantages of each. The doctors will also inform you if you are a good candidate for the laparoscopic procedure.
Types of surgery
There are two possible sources for a donated kidney for a transplant: a deceased donor kidney and a living donor kidney.
Deceased donor kidney
A deceased donor kidney comes from someone who has died from an accident in which the kidneys are not damaged and remain fully functional or from someone who has died from an illness or disease which does not compromise the kidneys.
Living donor kidney
A living donor kidney can come from a related family member such as a brother, sister, parent or child. A living donor kidney can also come from an unrelated donor such as a spouse, friend or altruistic donor.
Advantages of living donor kidney
There are several advantages a living donor kidney has compared to a deceased donor kidney:
- Closely matched donor—Living donation increases the possibility of obtaining a closely matched related donor kidney. In general, the better the match, the better the chances for long-term survival of the transplanted kidney.
- Faster transplants—A living donor evaluation can be completed in few weeks and the transplant surgery can be scheduled shortly thereafter. This allows the recipient to receive a kidney much sooner than a deceased donor kidney, which has an average wait time of three to four years.
- Improved outcomes—Research has shown that the less time spent on dialysis prior to transplantation, the better the outcome in terms of both short and long term function of the transplanted kidney.
- Scheduled surgery—Having a living donor allows the transplant center and the candidate to schedule the transplant surgery, allowing the patient to prepare for the surgery and post-transplant recovery time.
Each donor's recovery is unique, but the donor can reasonably expect to remain in the hospital for two to three days following surgery as long as there have been no complications. Generally, donors who have the laparoscopic surgery require a shorter recovery time than donors who have the traditional surgery.
Most donors are able to fully return to their normal routine in about six to eight weeks following surgery. You will need to have regular physical checkups with a doctor during your recovery period to monitor your progress and address any problems that might arise.
Type-1 diabetes is a disease in which the pancreas has stopped producing the hormone insulin, which is responsible for controlling blood glucose (sugar) levels. These patients must take insulin in order to survive. Approximately 13,000 people annually in the U.S. are diagnosed with Type-1 diabetes – mostly children and adolescents. Type-1 diabetes is typically treated with strict glucose monitoring, multiple insulin injections daily and dietary restrictions.
If left uncontrolled, high levels of glucose can result in long-term damage to the patient's eyes, blood vessels, kidneys and nerves. Diabetes is a major risk factor for amputations, blindness and kidney failure requiring dialysis. Acute irregularities in glucose control can result in either hypoglycemic unawareness – a condition in which low blood glucose impairs cognition — or diabetic ketoacidosis — a life-threatening condition associated with swelling of the brain, seizures and heart arrhythmias.
Pancreas transplant at the Riverside Community Hospital Transplant Center
Successful pancreas transplant results in the restoration of insulin production. The new pancreas typically will start making insulin within a few minutes of being transplanted. Long-term, pancreas transplant patients are relatively free of diabetic dietary restrictions, free of hypoglycemic unawareness and ketoacidosis and can actually improve eye and kidney disease associated with long-term diabetes.
There are three types of pancreas transplants:
- Simultaneous kidney-pancreas (SPK)—This will be offered to patients with kidney failure secondary to Type-1 diabetes. Transplanting both organs at the same time corrects both the kidney failure and diabetes. Only one transplant surgical procedure is required. Patients can expect to enjoy freedom from dialysis and freedom from insulin.
- Pancreas-after-kidney (PAK)—Those suitable Type-1 diabetics who have already received a kidney transplant (either living donor or cadaveric) may be offered pancreas-after-kidney transplantation (PAK).
- Pancreas transplant alone (PTA)—This procedure will be offered to patients with Type-1 diabetes if they are experiencing hypoglycemic unawareness. These patients have not experienced kidney failure.
Patients are evaluated by means of a multidisciplinary approach that ensures a comprehensive assessment of the patient. This serves two purposes. First, the transplant team is able to evaluate each candidate for risk factors or contraindications to pancreas transplantation. Second, the patient and family members are able to decide if pancreas transplantation is suitable for them.
Patients with Type-1 diabetes may be referred to the Riverside Community Hospital Transplant Center from their dialysis center, primary physician or nephrologist, other transplant centers or through self-referral.
The transplant recipient is taken to ICU after surgery where IV fluids and medications will be administered through the central line. Vital signs are monitored continuously and the bladder is kept empty by a catheter. There will be some pain in the surgery site, so pain medication is normally administered through a patient controlled device to assure adequate pain control. Some patients may experience bladder spasms from the catheter and/or throat discomfort from the tube placed during surgery. These discomforts are only temporary and should disappear within a few days.
After the patient is settled, family and friends will be allowed to visit. Most patients are sleepy from the anesthesia and pain medication during this time.
Preventing complications after surgery is a major goal of nursing care. Lung infections, constipation and risk of blood clots in the kidney, legs, heart, lungs and brain are potential complications after the operation. To decrease those risks, patients are asked to do the following:
- Begin deep breathing and coughing exercises once awake after surgery.
- Frequent use of the incentive spirometer (breathing exercise equipment) while awake.
- Get out of bed as early as the first day after surgery.
- Walk in the hallway, increasing the distance every day.
From the ICU, the transplant patient is moved to the renal unit between 24 to 48 hours after the surgery. Rehabilitation includes activities like walking in the hallway several times a day. Extensive instruction is provided for both patients and their families to ensure a smooth transition from hospital to outpatient care. These instructions cover medications, signs and symptoms of rejection and other complications, as well as diet and exercises and what the patient can do to improve recovery.
The daily routine
Daily blood samples
Daily blood samples
Blood will be drawn daily to monitor progress and to adjust daily medicines.
- Kidney function - BUN, creatinine, electrolytes and red blood count
- Medication side effects - white blood count, liver panel and lipid panel
- Medication levels – Cyclosporine and Prograf
Each patient is weighed daily before breakfast to monitor weight change. Increases in weight usually result from fluid retention.
Measuring fluid intake and output
As soon as the patient arrives on the kidney floor, nurses will begin patient education. This includes how to keep track of all the liquids taken by mouth. At the same time the nurse will note all the fluids given by IV as well as the urine output. An appropriate fluid balance is important for the proper functioning of the transplanted kidney.
The purpose of an ultrasound is to observe the blood flow through the kidney and to find possible obstructions in the kidney or fluid collections around the kidney.
This is a special X-ray of the transplanted kidney. A radioactive substance is injected into a vein and pictures are taken of the kidney to see how it absorbs and excretes the substance. This procedure shows the blood flow and function of the kidney as well.
During the hospital stay and transplant clinic, members of the transplant team ensure that transplant patients have the knowledge and skills necessary to take an active role in maintaining a healthy lifestyle by providing extensive teaching and support. Transplant patients are required to:
- Make lab and clinic visits as ordered by the transplant physician.
- Measure vital signs, weight, fluid intake and urine output daily.
- Note above results in a diary. This dairy is then reviewed in the clinic.
- Take medications at regular intervals, mostly twice a day, 12 hours apart.
- Be in charge of keeping an adequate supply of medications at all times.
- Report any changes in their wellbeing.
- Report any changes in their circumstances, such as phone number or address changes, to the transplant center to ensure a seamless collaboration between patient and transplant team.
Transplant patients will be followed in the transplant clinic for six months, then discharged to their nephrology office. They are expected to return to the transplant clinic annually around the time of their transplant anniversary. As long as the transplant is still functioning, the transplant center keeps responsibility for all their patients by providing regular update reports to the United Network for Organ Sharing (UNOS).