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Evaluation and Waiting
Evaluation for Pancreas Transplantation
Patients who are being evaluated for pancreas transplantation meet with all members of the pancreas transplant team and undergo numerous lab tests and procedures. This thorough process allows the transplant team to determine whether a transplant is the right treatment, or if other treatments can help control the patient's diabetes and its complications.
The following tests are included in the evaluation process:
- Blood tests for blood type and tissue typing (HLA) for organ matching, and screening tests for immunity to, or the presence of, specific viruses, including HIV.
- Hemoglobin A1c (blood test) for diabetes control and a c-peptide test to evaluate the ability of the pancreas to produce insulin.
- Additional blood tests may be used to determine how well other organs are functioning.
- A chest x-ray to check for any lung problems.
- Urine culture to test for infection.
- An EKG, echocardiogram and/or stress test to check the heart and heart valves. This will aid the team in deciding if the patient's heart function is strong enough for transplant surgery, or if additional cardiac testing and treatment is needed.
- Pulmonary function tests, especially if the patient has a history of smoking or a history of lung disease.
- PPD to detect any exposure to tuberculosis.
- Mammography in women over 40 years old.
- Colonoscopy in patients over 50 years old.
- PSA in men over 40 years old.
- PAP smear in women over 21 years old.
Additional tests and consultations may also be needed based on initial results or family history. For example, patients may require a chest CT scan, abdominal CT scan, upper endoscopy, carotid duplex studies and/or bone density testing. Patients may be referred to doctors on another service – a hepatologist (liver doctor), pulmonologist (lung doctor), urologist (bladder doctor) or a cardiologist (heart doctor) – for some of these tests.
Once the initial evaluation is completed, each patient's case is discussed at the Kidney/Pancreas Transplant Selection Meeting, and doctors there decide whether or not to recommend pancreas transplantation, or to gather more information. Patients who are deemed to be appropriate candidates for pancreas transplant will be listed with the United Network for Organ Sharing (UNOS) in order to receive a donor organ when it becomes available.
Dealing with Uncertainty
Waiting for a suitable donor pancreas may take many months to years. Transplant recipients and their families often describe this waiting period as the most difficult part of the entire transplant process. Because fear and anxiety are normal reactions during this period of uncertainty, doctors here often suggest that transplant candidates and their families attend support groups and avail themselves of the many support services available at the Hospital. These resources are available to assist patients and their families with the multi-faceted challenges associated with the organ transplantation process, and are helpful in providing encouragement, confidence, support, and practical information.
While You Wait
- Stay in good health. When a donor organ becomes available the patient should be in the best possible physical condition. Good health makes it more likely that transplant surgery can proceed and that the patient will recover quickly after the transplant.
- Stay in close touch with the team. Keep the transplant team's phone numbers accessible at all times, contact the team if any new health issues develop, and be sure to have regular checkups with the transplant team. Each patient is assigned to a Transplant Coordinator who will be his or her primary contact during the waiting period.
- Be accessible at all times. When a donor pancreas becomes available the hospital must respond immediately. If a patient is unavailable or unable to have the transplant (due to infection, for instance) the organ may be offered to the next person on the wait list. Carry a pager or mobile phone so that you can be reached at any time.
- Be ready to go. Have a transportation plan so that when a donor organ becomes available you are able to quickly and easily travel to the hospital.
- Learn what to expect. While waiting for surgery patients should learn about the recovery process and about the medications they will need to take after surgery.
- Plan ahead. Prepare an advance directive, a document that allows you to designate someone to make health-care decisions for you in the event that you cannot communicate yourself. Stipulate your wishes about the use of life-sustaining procedures and treatments.