Kidney Transplant The Preferred Treatment for Most Patients with Kidney Failure Information for Patients July 2018

Topics Transplant as a treatment option Benefits of a transplant Types of transplants Eligibility for transplant Assessing suitability for transplant Transplant surgery and follow-up Finding a living donor July 2018

What is a Kidney Transplant? An operation (surgery) which places a healthy kidney inside your body. July 2018

Why Consider a Kidney Transplant? Dialysis is not needed Most transplants last over 10 years Compared to dialysis, people with transplants often: Live longer than those on dialysis Have better health and energy Live a more “normal” life: Eat and drink with fewer restrictions Do regular daily activities Enjoy more freedom, including travel July 2018

Types of Transplant Living Donor Transplant The kidney donor is alive Can be done before dialysis is needed (“pre-emptive”) Shorter wait time Actual wait time depends on blood group and presence of antibodies. Deceased Donor Transplant (dialysis patients only) The kidney donor has died Must be on dialysis before being placed on the waitlist Waitlist is 2 to 8 years July 2018

Benefits of Living Versus Deceased Donor Transplants from living donors: Last longer Have a lower risk of rejection Allow better overall health If pre-emptive, diet restrictions and health complications may be avoided Shorter waiting time for transplant Talk with your Kidney Care Team about finding a living donor. Resources are available. July 2018

Process - Living vs Deceased Donor July 2018

Am I Eligible for a Transplant? Because kidney transplant is a complex surgery and requires taking anti-rejection drugs and medical follow up for the rest of your life, your team will make sure this is suitable for you. **Anti-rejection medications are provided without cost to you and are usually well tolerated. July 2018

Am I Eligible for a Transplant? Your kidney care team will assess your overall health. They will assess the impact of transplant and follow-up care for you They will review any other medical conditions you have They will review your supports Many patients find it helpful to talk with their social worker about ways to navigate system challenges. **There is no specific age cut-off but most transplant recipients are < 80yrs July 2018

Transplant is a Possibility… What’s next? You will be referred to the transplant team at St. Paul’s Hospital or Vancouver General Hospital. Your current (local) kidney care team will start the workup (e.g., blood type, cardiac tests, cancer screening). The transplant team will: Complete additional tests (Ideally in your home community - some travel to Vancouver is required) Let you know if transplant is suitable for you *People with a potential living donor are assessed more quickly. July 2018

I am Suitable for a Transplant… What’s next? If you have a living donor, transplant surgery will be arranged when your GFR starts to fall (usually at 15 or less). If no living donor is involved, you will be put on the deceased donor waitlist when you start on dialysis. July 2018

What Does the Surgery Involve? Your original kidneys are usually left in place. The transplanted kidney is placed in your lower abdomen (belly). Surgery takes 3-5 hours. Stay in hospital 5-7 days. July 2018

What happens after Surgery? You visit the Transplant Centre: Twice a week for the first month Once a week for 2 months Frequency of visits will decrease over time If you live outside the Lower Mainland you will need to move to Vancouver for 2-3 months after your transplant. Your social worker can help with planning. Once you are stable, the team will arrange follow-up care at a Post Transplant Clinic closer to your home. July 2018

How Do I Find a Living Donor? Finding a living donor can seem difficult. You may feel a range of emotions and concerns as you consider talking to others about donating a kidney. You may feel: Confused about who could be a potential donor Hesitant to ask a potential donor Unsure of how to go about it Disappointed that no one has offered to donate Concern about the impact on the donor and their daily life Fear for the future health of the person donating Anxious about feeling indebted to the donor Concerned your relationship with the donor may change. Mar 10, 2018

How Do I Find a Living Donor? Remember You are not alone in this process. Your kidney care team will give you information, tools and support to make you more comfortable with the process and help you succeed in finding a living donor. July 2018

How Do I Find a Living Donor? Think about people or groups to approach Start with people closest to you: Family, friends, co-workers, neighbours People from church or clubs & organizations The donor pool is often greater than you think. Did you know? Donors do not have to be blood relatives or same blood type. Donors do not have to live in BC. People often offer to donate without being asked. Many feel donation is a natural fit for them. July 2018

How Do I Find a Living Donor? Some ways to reach out to individuals or groups: Personal conversations. Writing letters or e-mails. (We can share some sample outreach letters) Using Facebook or other social media. Your social worker can guide you to do this safely. Ask a friend or family member to be a “donor champion” to help get the word out. July 2018

Living Donation: the Process Key points for potential donors They can gather information and be assessed before before making a commitment to donate. They are screened carefully to make sure they are medically OK to donate a kidney. They can live healthy, normal lives with one kidney. The assessment process is confidential. Mar 2, 2018

Living Donation: the Process Key points for potential donors At any time a prospective donor can choose not to proceed with the donation. A donor must start the screening process by contacting the Living Donor Team at Vancouver General Hospital or St Paul's Hospital. If a donor is not a match, they may participate in a national paired exchange with other non-matching donor and recipient pairs. July 2018

Living Donation: the Surgery Donor surgery: Is done on the same day as for the recipient Is booked in advance and allows time for planning Occurs in Vancouver, usually requires 2-4 nights in hospital Out-of-town donors should expect to stay a week in Vancouver Most donors: Return to light activities within 2 weeks (e.g., driving) Return to full activities within 6-12 weeks Return to work after 4-6 weeks if their job does not require lifting or physical activity July 2018

Living Donation: Practical Help Pre-emptive transplant allows for planning and organization. Family and friends often volunteer to help with transportation, household chores and child care. Some donors may also be able to access private benefits and employment insurance. Most employers recognize kidney donation as a legitimate medical reason to be off work. July 2018

Living Donation: Practical Help Programs which support living donors: Living Donor Expense Reimbursement Program can help donors with costs, including time away from work. www.kidney.ca/britishcolumbia/loderp Living Donor Mentor Program can match potential living donors with mentors who have already donated a kidney. Call 1-866-390-PEER (7337). www.kidney.ca/britishcolumbia/peer- support July 2018

Living Donation: Keys to Success Provide regular updates to your family and friends about your health. Invite donors to contact the Transplant Centre for more information. Multiple donors can come forward at the same time. Understand that finding a donor can take a while. Trust the process and your kidney care team—they will support you through this. July 2018 23

Resources for Patients and Donors BC Transplant www.transplant.bc.ca BC Renal Agency www.bcrenalagency.ca BC Kidney Foundation www.kidney.bc.ca Ph: 604 -736-9775/1-800-567-8112 July 2018

Contact Information Vancouver General Hospital Transplant Team ph: 604 875-5182/1-855-875-5182 kidneydonornurse@vch.ca St. Paul’s Hospital Transplant Team ph: 604 806 9027/1-877-922-9822 donornurse@providencehealth.bc.ca July 2018