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 Living Donor Pre Assessment Clinic including final meeting with surgeon, anaesthetist, pharmacist and Transplant co-ordinator.

By law you have to have some medical checks done within 2 weeks prior to the operation. This is to ensure that you are fit and healthy just prior to the operation. Some of the evaluation tests were done a few months ago, so up to date ones would be required. 

I arrived early in the morning at the hospital, knowing I would be there most of the day. Here is a list (as presented to me at the hospital) as to what the day would hold. I was at the hospital for around 5 hours and the following took place but not necessarily in this order:

Tests I had done:
1. Blood and urine samples (they took 20 tubes of blood! yes .. 20!)
2. MRSA swab (gave me a loooong q-tip I had to wipe the inside of my nose with)
3. Chest X-ray
4. ECG

I was seen by:
1. Consultant Surgeon
2. Anaesthetist
3. Pharmacist
4. Transplant Co-ordinator

1. Consultant Surgeon:
My Consultant Surgeon explained that he would not be available to do the operation.  There would be two other surgeons. He told me a bit about them. I was a little unsettled about this, as familiarity of people/faces goes towards a relaxing atmosphere and I felt I knew my current  Surgeon and felt very relaxed in his company. But then I thought I am going to be out of it anyway under anaesthetic, so won’t really matter, so I was okay with that.

The surgeon went through the procedure from admission to after the operation. He drew a picture showing where the incisions would be and why. There would be a small incision just above the belly button, through this the camera would go.  Two more would placed to the right of the camera incision – one just under the rib cage and the other same distance below the camera one. Through those two the surgical instruments would go. My surgeon comically called them “chopsticks”. Another small incision would go to the right of the one just under the rib cage. Through this incision an instrument would go that would move the liver out of the way which is very close to the right kidney. Those four small incisions would be around 1-2cms (the one above the belly button actually ended up around 4cms the others were very small though). The final incision is along the bikini line and would be around 6 inches. It is through that the kidney is extracted.  He also explained that it would be hard to move around in my abdomen as not much room, so they inflate me like a large balloon with carbon dioxide. An after effect of this could be that some gas could escape up into the shoulder blade area and afterwards cause some discomfort for a few days (it did! lol).
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I thought it might help to just go over what has happened so far, and the evaluation stages left.

I had an initial consultation with the surgeon and a Transplant Specialist Nurse. Various questions regarding my health, past and present and my families health as far as any illnesses they may have had.  My weight and height were checked.

Blood pressure
This gets taken as high blood pressure can cause damage to the kidneys.  Blood pressure is taken more than once during the evaluation period. 

Urine sample
Urine sample is taken and checked for underlying problems such as glucose, protein, bacteria, etc.

I have had blood taken three times and  checked for a variety of things. Blood group, tissue type …. infections, all sorts of things are checked for to make sure you are quite healthy.

Blood tests
Blood samples will be taken which is checked for blood group, tissue type, can show if there is anaemia, various infections etc etc . Various checks on the blood are done to make sure you are quite healthy and the kidney and liver are functioning okay ….

X-rays
A chest x-ray was taken.

Electrocardiogram (ECG)
I had an ECG (Electrocardiogram) where you have electrodes placed on you and your heart is monitored and the electrical impulses of the heart are recorded onto a graph and from that they can tell if there are any weaknesses in the heart.

Renal ultrasound
This is a non-invasive scan.  It  checks that there are two kidneys. Some people are born with only one kidney but are totally unaware of the fact.  The ultrasound can show the size of the kidneys, if there is any scarring or obstructions.   I had a small scar on the top of the right kidney which was probably due to an infection as a child.  It did not affect my ability to donate.  For those who have never had an ultrasound (most pregnant mums have) – then for a kidney ultrasound they wanted it done on a full bladder (that was the hardest part ..lol…). A gel is put onto your abdomen/side and then the technician moves a probe over your abdomen and sides and the probe can “see” your kidneys.  Once she had done the part that required the full bladder I was allowed to go and pee ! Then came back for the rest of the ultrasound. It is totally painless, not at all uncomfortable. The gel was a bit cold but that was all.  None of the tests I have had have been at all uncomfortable.  

A doctor was assigned to me to make sure that everything was being done that should to ensure I was healthy and fit enough to donate.  He checked my weight and height.  Asked me a few questions.   Listened to my heart which sounded okay. Blood pressure was 138/81. Peripheral pulses were present.  His opinion was that I was fit to proceed for further evaluation.  Ideally though I should lose some weight (being 89kb with a height of 1.6m). I also take HRT and was recomended I come off that for the donation. 

(Note: I do not take any form of  HRT which is derived from pregnant mares – such as Premarin etc.  I take kliovance which is plant based.  Speak to your doctor about switching if you are concerned about how the medication is produced).

I am working on the weight loss …. !

I saw the psychologist (see previous blog entry) and that is all fine.

Still to come ….
Psychiatrist Assessment
I am waiting to hear my appointment date for this.  They need to make sure I am fully aware of what I am committing myself to; that I am mentally okay and freely consenting to this procedure.

DMSA
This I have yet to have. It This is where they have to check the anatomy of each kidney. Arteries and veins have to be identified. It is not unusual for a kidney to have more than one artery.  These results go towards making a decision as to which kidney will be removed.   

GFR Test (Isotope Glomerular Filtration Rate).
I also have this to come. I believe I will be having this same day as the DMSA. The GFR is a test to assess the capability of the kidney to ’clear’ the blood of a substance. A small amount of dye is injected into a vein and blood samples are taken at hourly intervals for three/four hours, to measure the renal clearance of the dye. 

Finally I have to see the Consultant Nephrologist again  as he gives the final decision as to whether I am medically fit enough etc to donate a kidney.

All the information is given to an independant Assessor and I have a meeting with him. He  needs to make sure I understand everything etc etc. He then makes a report and presents to the Human Tissue Board and seeks their permission for the donation to go ahead.  The producing of the report and seeking permission can take up to a month in total.

It was explained to me that there was no guarantee that it would be keyhole surgery.  The surgeon would make that decision once both kidneys had been evaluted etc. It is not unusual for a kidney to have more than one artery and vein and if it turns out that there are two or three arteries and/or veins etc, it maybe that the operation would easier  with open surgery.  So that does affect recovery time.  Keyhole surgery – the stay in hospital is shorter by a couple days I believe and the recovery time  is much quicker.

I have some personal committments late Autumn  that are a must to keep and may involve physical activity. So allowing enough time for the donation and full recovery, it may be difficult to make the actual donation any earlier than late November/December.  That is fine and allows plenty of time for the rest of the tests and assessments to take place. Approval for the donation will be sought once my committments are over.  I certainly don’t want to be under any pressure during my recovery especially as I don’t know if keyhole or not – so need to be sure  there is plenty of time afterward to get back to normal.

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