Kidney Transplant
Evaluation

During the evaluation for a kidney transplant, a transplant coordinator will arrange for a series of tests to assess your child's treatment options. The transplant staff will discuss any medical problems that need to be evaluated before the transplant, such as heart disease, infections, bladder dysfunction, ulcer disease or obesity. A social worker will meet with you to assess transportation, housing, financial and family support needs, and a financial counselor will meet with you to ensure you understand the covered benefits of your insurance policy.

We encourage you to ask questions and learn as much as possible about the transplant process before making a decision. You do not need to reach a decision by the end of the session.

Screening Tests

Regardless of the type of kidney your child may receive — from a living donor or a deceased donor — special blood tests are needed to determine your child's kind of blood and tissue. These test results help to match a donor kidney to your child.

Blood Type Testing

The first test establishes your child's ABO blood type. There are four blood types: A, B, AB and 0, and everyone fits into one of these groups. The recipient and donor must have either the same blood type or compatible ones. The list below shows compatible types.

  • If your child's blood type is: A
    The donor blood type must be: A or O
  • If your child's blood type is: B
    The donor blood type must be: B or O
  • If your child's blood type is: AB (universal recipient)
    The donor blood type must be: A, B, AB, or O
  • If your child's blood type is: O (universal donor)
    The donor blood type must be: O

Patients with AB blood type, called the universal recipient, are the easiest to match because they accept all other blood types. Blood type O, called the universal donor, is the hardest to match. Although people with blood type O can donate to all types, they can receive kidneys only from blood type O donors. For example, if a patient with blood type O were given a kidney transplant from an A donor, the recipient's body would recognize the donor kidney as "foreign" and destroy it.

The Rh type (+, -) is not a factor in donor matching.

Human Leukocyte Antigens (HLA)

The second test, which is a blood test for human leukocyte antigens (HLA), is called tissue typing. These antigens are substances found on many cells of the body, but are mostly seen on white blood cells. Tissue type likeness between family members may be 100, 50 or 0 percent. The tissue type of all potential donors is considered in donor selection.

The prospective recipient and all family members and non-relatives interested in donating a kidney can make arrangements with the transplant team for tissue typing. No special preparation is required and results are available within two weeks. Pre-packaged kits with instructions about how to collect and return blood samples are available to mail to out-of-town relatives. The necessary blood can be drawn at a local physician's office or hospital laboratory and sent back to us via overnight mail.

Crossmatch

Throughout life, our bodies make substances called antibodies that destroy foreign materials. We may make antibodies each time we have an infection, have a blood transfusion or undergo a kidney transplant. If your child has antibodies to the donor kidney, the kidney will be destroyed. For this reason, we conduct a test to ensure that your child doesn't already have antibodies to the donor when a donor kidney is available. This test is called a crossmatch.

The crossmatch is done by mixing your child's blood with cells from your donor. If the crossmatch is positive, it means that your child has antibodies against the donor and should not receive this particular kidney. lf the crossmatch is negative, it means your child doesn't have antibodies to the donor and is eligible to receive this kidney.

Crossmatches are obtained several times during preparation for a living-related donor transplant, particularly if donor-specific blood transfusions are used. A final crossmatch is performed within 48 hours before the transplant.

Serology

Testing is done for potentially transmissible diseases, such as HIV (human immunodeficiency virus), hepatitis and CMV (cytomegalovirus).

Transplant Waiting List Placement

Once the evaluation is complete, the transplant team will meet and a decision is made whether or not to place your child on the transplant waiting list. This decision is made only after discussing each case with the nephrologist, surgeon, transplant coordinator, social worker and financial counselor. You will be notified when your child's name is placed on the United Network for Organ Sharing national transplant waiting list.

If a transplant isn't in your child's best interest, a transplant team member will call and discuss other options with you.

Living Donor Testing

Kidneys for transplantation come from either a living donor or a cadaver. When a living person donates a kidney, his or her remaining kidney will enlarge as it takes over the work of two kidneys. As with any major operation, there's a chance of complications, but kidney donors have the same life expectancy, general health, kidney function and activities as most other people. Any healthy person can donate a kidney. Sometimes a family member or close friend may wish to donate a kidney. A donor must be in excellent health, well informed about transplantation and able to give informed consent.

If you have a potential living donor, he or she will meet with a transplant surgeon and a transplant coordinator during the evaluation process to discuss the possibility of organ donation. We will perform tissue typing and other tests to determine if the potential donor is suitable. In some families, several people may be compatible donors. In other families, none of the relatives or non-relatives may be suitable.

For more information, please see our Becoming a Living Kidney Donor pamphlet.

Reviewed by health care specialists at UCSF Benioff Children's Hospital.

Related Information

UCSF Clinics & Centers

Organ Transplant

Kidney Transplant Program
1825 Fourth St., Sixth Floor
San Francisco, CA 94158
Phone: (415) 353-8377
Toll-free: (800) 482-7389
Appointment information

Pediatric Dialysis Unit
1825 Fourth St., Fifth Floor
San Francisco, CA 94158
Phone: (415) 353-2425
Fax: (415) 353-2768
Appointment information