[Text on screen: Welcome Transplant Recipient Education Session. Kidney-Pancreas] [Music playing] Welcome to the education session for potential kidney, pancreas, or kidney-pancreas transplant recipients. This is your opportunity to learn more about the kidney and kidney-pancreas transplant program here at Ohio State, including the evaluation process and follow up care. It is also a chance for you to get to know a little bit more about The Ohio State University Wexner Medical Center and the care team at the Comprehensive Transplant Center. We want to first introduce you to the three core groups of kidney, pancreas, and kidney-pancreas transplant doctors here at Ohio State's Wexner Medical Center. If you are having a kidney or kidney-pancreas transplant, you'll be evaluated by either a transplant nephrologist or transplant surgeon. This doctor will evaluate you for transplant but will not be the doctor that follows your care. You will continue to see your primary nephrologist for your kidney care. If you are having a pancreas or kidney-pancreas transplant, a transplant endocrinologist may also be consulted to review your diabetes history during your evaluation and then also help monitor your new pancreas once transplanted. Since the call to receive a new kidney and/or pancreas can occur anytime, day or night, all our doctors work seamlessly together to provide your care. The kidney, pancreas, or kidney-pancreas transplant process can seem very complicated. In order to make it easier to understand, we've broken the process down into seven steps, so you will have a better understanding of what to expect along your transplant journey. The first step is the referral phase. The fact that you are watching this video means that you have already been referred for transplant consideration. Step two, the education phase, is why you are here today and it often occurs simultaneously with step three, testing, and step four, evaluation. Testing for transplant evaluation starts as soon as your medical insurance provides approval. You'll be scheduled in the transplant clinic to meet with some or all of the following team members: a transplant surgeon, a nephrologist and/or endocrinologist, a transplant coordinator, transplant dietitian, transplant social worker, and transplant financial coordinator. Once the testing and evaluation are completed, your case will be discussed at step five, the patient selection committee, that meets weekly. If recommended by this committee for transplantation, you'll be placed on the transplant wait list, step six, until you get the call for transplant. Step seven, the last step along your journey before surgery. If you are a potential pancreas or kidney-pancreas recipient, there is an extra step after the patient's selection committee that requires approval by the Ohio Solid Organ Transplant Consortium, which is usually received in 48 hours. The fact that you are watching this video means that you have already been referred for transplant by your physician or dialysis center, you have kidney disease, and are either on dialysis or are headed towards dialysis. Most referrals are made when the glomerular filtration rate or GFR is near or below 20. GFR is a blood test that checks how well your kidneys are working to remove waste and excess fluid from our blood. Treatment options for kidney disease include different types of dialysis, palliative care, or transplant. It is important to remember that transplant is not a cure. After kidney transplant surgery, you will still have kidney disease and may need some of the medicines you took before transplantation. You'll also need to continue to be careful with your health. A pancreas transplant is an option for some people with Type 1 diabetes, an autoimmune disease in which the pancreas stops producing the hormone insulin. The usual treatment for Type 1 diabetes involves daily injections of insulin. Pancreas transplant is an alternative option but is not a cure for the underlying disease that caused pancreas failure. If you have kidney failure from your diabetes, your nephrologist or surgeon may also recommend a kidney transplant at the same time. Kidney transplant can be a life-saving procedure that allows you to have an improved quality of life and a decrease or end to your symptoms. After transplant, your new kidney will be doing the job it is supposed to be doing, removing waste products and extra fluid from your body. And since your body's organ systems are all connected, the rest of your body will be able to work better, giving you more energy and improving your overall well-being. If you were on dialysis before your transplant, you may experience more personal freedom without having to follow a dialysis schedule. Studies also show that in most cases, the survival after transplant is longer than the survival on dialysis. If you're having a pancreas transplant, your new pancreas will be doing the job it is supposed to be doing, producing hormones, including insulin, that help regulate blood sugar. The benefits of a pancreas or kidney-pancreas transplant include no longer needing to take insulin, the ability to eat a regular diet, and having few to no episodes of low or very high blood sugar. The risk for kidney damage from diabetes is also decreased after a successful pancreas transplant. There are risks with any surgery like a kidney or pancreas transplant. The two biggest risks are infection and organ rejection. Your medical team will go over these risks and speak more about them with you during your clinic evaluation. After transplant, you'll have to take anti-rejection medicine, also known as immunosuppression medications, every day for the rest of your life. These medicines weaken your immune system to prevent it from attacking your new organ. Your body is still able to fight off infections like colds or flus, but you will be more likely to catch an infection while taking the immunosuppression medications. You'll have frequent blood work to monitor the levels of medication in your blood to ensure the level is good enough to prevent your body from attacking your new organ but not too high that you can't fight off infection. Your medical team will talk with you more about medications needed for transplant and the risks of transplant in relation to your individual health problems. After transplant, when welcoming anyone to your home, all visitors should wash their hands. Frequent hand washing from you and those around you will significantly reduce your risk of infections. Everyone who is evaluated for kidney, pancreas, and/or kidney-pancreas transplant undergoes the same initial evaluation testing that may include abdominal imaging, blood testing, cardiac testing, lung testing, and a chest x-ray. Additional testing may be needed for your case depending on your particular medical conditions. Cancer screenings are very important for potential transplant candidates. Immunosuppression medications given to prevent organ rejection can lower your healing ability and turn on cancer cells, sometimes causing them to grow and multiply. For this reason, transplant candidates need to have a dental clearance within the last year to rule out oral cancer or signs of infection and a colonoscopy, if you are over the age of 50 or have other colon cancer risk factors. Females need to have a pap smear within the last year plus a mammogram, if you are over 40 years of age or have a family history significant for breast cancer. Males need to have a PSA level drawn in clinic, if you are over 50 years of age, or earlier if there is a high risk of developing prostate cancer. Prior to your in-person clinic appointment, you'll receive a phone call from your transplant nurse coordinator who will be your main point of contact for transplant related questions during the evaluation process. During this initial phone call, your transplant nurse coordinator will review your health history, medications and answer any questions you may have about the transplant process. It is important that your phone have a working voice mailbox for the nurse coordinator to leave messages with a callback number in the event that you can't be reached. Receiving this phone call can significantly shorten the amount of time needed for your in-person clinic evaluation appointment. For your clinic appointment, please remember to bring one support person with you along with a list of your medications and an insurance card, eat and drink prior to your appointment, and stay hydrated as you will have blood drawn for testing. As part of your clinic evaluation, you will speak with several caregivers. Social worker evaluation includes an in-depth discussion covering topics such as your background information, living situation, support system, income, work history, drug and alcohol history, and mental health history. The social worker will also meet with your support person to evaluate their ability to support you during the transplant process and after surgery. This part of the evaluation occurs after you complete this education session. Your insurance status is very important for being placed on the waitlist and remaining active. The transplant financial coordinator will verify your insurance benefits for transplant evaluation and transplant surgery as well as your pharmacy benefits for the medicines you will take for the rest of your life after transplantation. The financial coordinator will also work to obtain authorization from your insurance company, if needed, for your transplant evaluation and will discuss your specific financial situation and answer your insurance questions. Prior to your transplant evaluation, a transplant financial counselor will contact you to discuss your financial situation to assure that all of your financial needs can be met. The financial evaluation will take approximately 15 to 30 minutes and will cover information such as income, assets, resources, monthly expenses, and any financial concerns. Please note, it is very important that you stay current on your Medicare Part A and Part B premiums before and after transplant. This coverage is essential for your anti-rejection medications. Because your nutrition is an important factor to the success of your transplant, you may also meet with a transplant dietitian. This nutritionist will review the medicines you are taking, including vitamins and herbal supplements, go over your nutrition history such as diabetes diagnosis and management, discuss recent weight changes, both gains and losses, review your eating habits and any eating issues, check on your food allergies, discuss oral nutrition supplements like Ensure and Boost that you take or have previously taken and will perform a nutrition focused physical exam. Every patient is different, so based on your needs, the dietitian may point out opportunities for improving your overall nutritional health. During your physician appointment, it is a good time to ask questions and clarify information about the transplant with a nephrologist or transplant surgeon. This doctor will review your medical history and current health to decide if additional testing is needed to evaluate you for transplant. It is important to have completed the screening phone call with your transplant nurse coordinator prior to meeting with the physician. Kidney and Pancreas Patient Selection Committee, also referred to as PSC, is a multidisciplinary group made up of transplant nephrologists, endocrinologists, transplant surgeons, cardiologists, psychologists, pharmacists, dietitians, social workers, transplant nurses, and financial coordinators. The PSC discusses your case and decides the best treatment option for you, taking into consideration your medical history, ability to care for your future kidney and/or pancreas transplant, any potential surgical complications, your support system, potential completion of an alcohol and/or drug treatment program if needed, and your engagement in the transplant process. The kidney and pancreas PSC follows a set of guidelines to determine if a patient can be placed on the transplant wait list. These guidelines outline the criteria for transplant and have two categories: absolute contraindications and relative contraindications. These criteria standards were developed to improve the chance of long-term survival with a transplanted kidney and/or pancreas. The first guideline category, called absolute contraindications, lists a set of instances that will stop a patient from being listed for transplant at that time. This could lead to reevaluating at a later time based on the patient's need. Absolute contraindications include morbid obesity with a body mass index, BMI, greater than or equal to 45, which can be evaluated on a case-by-case basis, active untreated infections that affect the entire body, chronic illness with life expectancy of less than one year, and active cancer. If you meet any of these absolute contraindications, you may not be considered a candidate for transplant at this time. However, you can be reconsidered if there is a change in one of these conditions that allows you to meet the recommendations. The second guideline category, called relative contraindications, lists a set of instances that could potentially be unsafe for transplant surgery, but patients may still qualify for transplantation if the team feels the benefit of transplant outweighs the risks. Here is a list of relative contraindications. [Text on screen: Relative contraindications - Age Greater than 80 - HIV Active Infection - Ongoing Failure to Adhere to Medical Treatment - Inadequate Financial Resources - Uncorrectable Coronary Artery Disease - LV Ejection Fraction <20% (measurement of heart failure) - Active Viral Hepatitis with Significant End Stage Organ Injury - Active Peptic Ulcer Disease - Poor Functional Status - Morbid Obesity with BMI > 40 - Recent History of Cancer - Permanent Pulmonary Hypertension or Significant Lung Disease - Active Alcohol or Substance Use Disorder - Poorly Controlled Psychiatric Illness] Relative contraindications are evaluated on an individual basis, taking the rest of the patient's medical and social history into account. Patients may not be considered for transplant unless one or more of these contraindications are resolved. Other contraindications not listed here could arise on a case-by-case basis. Your provider and coordinator will discuss any identified contraindications and steps that you may be able to take to meet the recommendations of the PSC. After the Patient Selection Committee reviews your case, there are four potential outcomes. You may be approved for listing on the deceased donor registry and/or you may be approved for living kidney donation. You could also be told that additional testing is needed to make a good decision about your case or lastly, you may be told you are not a candidate at this time. If additional testing is required to complete your transplant evaluation, a member of the pre-transplant team will call and inform you of the decision and discuss additional required testing. If you are not a candidate for transplant at this time, please continue to follow up with your nephrologist and/or your endocrinologist. This doctor can work with you to help correct the situation preventing wait listing and can refer you for transplant evaluation in the future if the situation is resolved. There are two options for a patient on the kidney transplant wait list at Ohio State: a transplant from a living kidney donor or a transplant from a deceased donor from the wait list. If you have a compatible living donor, surgery can be scheduled as soon as testing is completed to avoid a lengthy wait time. Your placement on the wait list is determined by the United Network for Organ Sharing, also known as UNOS. UNOS matches donated organs with transplant candidates using guidelines to save as many lives as possible and provide transplant recipients with the best possible chance for long-term survival. [Text on screen: Blood Type and Other Medical Factors Determine Organ Allocation - O Negative - A Positive - AB Negative - B Negative - O Positive] Blood type and other medical factors determine the distribution, also called allocation, of every donated organ, but every organ type has a unique distribution policy. For example, donated lungs have a different distribution policy from donated livers. The same holds true for donated kidneys and pancreases. Specific factors taken into account for kidney distribution include the recipient's time spent on the wait list, compatibility of the donor and recipient's immune system, history of the recipient previously donating a kidney, distance from the donor hospital, and the survival benefit. Survival benefit is an estimated measurement of long-term survival after organ transplant and is measured by two different scores, the KDPI and the EPTS. First, the KDPI, or Kidney Donor Profile Index, estimates how long a kidney from a deceased donor will last after transplantation, compared to all other kidneys transplanted in the United States over the past year. The score can range from 0% to 100%. Kidneys with low KDPI, with scores between 0% and 20%, are estimated to have longer function time while kidneys with higher KDPI, between 85% to 100%, are estimated to have a shorter function timeframe. The second score, EPTS, or Estimated Post Transplant Survival, is a score given to all adult kidney transplant candidates on the wait list. It also ranges between 0% and 100% and is based on four factors: time on dialysis, current diagnosis of diabetes, prior solid organ transplants, and age. As a transplant candidate, your EPTS score only becomes a factor if it's 20% or less, which then qualifies you to receive organ offers from kidneys with low KDPI of 20% or less before anyone else. The EPTS and KDPI scores can be hard to understand but in the simplest of terms, this process matches kidneys estimated to have the longest use time with candidates estimated to need the kidneys for the longest period of time and the longer a recipient can go before needing another kidney transplant, the shorter the list is for others waiting. Many of our patients here at Ohio State do not fall into this low EPTS score range. [Text on screen: The Ohio State University Wexner Medical Center I will agree to receive a high KDPI kidney (85% to 100%), if one becomes available. I Consent] For this reason, we recommend that all patients consent to receive a kidney with a high KDPI score between 85% and 100%. Not all patients will be candidates for a high KDPI kidney. Since the score is only an estimate of kidney function time, allowing your surgeon to consider what is best for your health situation may enable you to be transplanted sooner before you get too sick for a transplant, and even if you sign the consent to receive offers for high KDPI kidneys, you will have the opportunity to speak with your transplant nurse coordinator and/or surgeon prior to accepting an offer. There is a handout in your education folder that further explains consent for high KDPI kidneys. We strongly encourage all patients undergoing evaluation for kidney transplantation to consider a kidney from a living donor. Even though you may find it a difficult ask, the best option is to receive a kidney from a living donor. Wait times for recipients are reduced from years to months, potentially avoiding dialysis. Since surgery can be planned, recipients have better outcomes. Kidneys from living donors are of higher quality and may last longer than kidneys from deceased donors, and it may lower the risk of rejection. About a third of the transplants performed at Ohio State are performed with kidneys from living donors. Often, living donors are family members but a growing number are friends or co-workers. There are also people who choose to donate a kidney without having a specific recipient in mind. These extraordinary people are called non-directed or altruistic donors. With any surgical procedure, there are also risks, both for the living kidney donor and kidney recipient. Living donors go through extensive testing to ensure that they are in the best health to undergo a major surgery and that donating a kidney will not cause them harm in the future. From 1999 through 2021, we performed more than 2,000 living donor kidney surgeries with no deaths. We did have a few patients experience complications including bowel obstruction, bowel injury, hernias, conversion from laparoscopic surgery to an open surgery, and blood transfusions. Our transplant physicians and coordinators will carefully outline and discuss all potential risks of the transplant during clinic evaluation. Sometimes, a person may agree to donate a kidney to a recipient but their blood or tissue type does not match that recipient. Our team can help match such a donor-recipient pair with another donor-recipient pair through a process called kidney paired donation. For example, if the recipient from one pair is a match with the donor from another pair and vice-versa, our living donor team can arrange the exchange through two simultaneous transplants. This allows the two recipients to receive organs from two people who are willing to donate even though the original pairings were incompatible or mismatched. Paired donation can also involve multiple donors and recipients. Ohio State has performed the largest living kidney donor chain in the state of Ohio with eight donors and eight recipients. That's a total of 16 surgeries within a one to two-day period and achievable due to our vast team of resources at our transplant center. All medically eligible donor recipient pairs may participate in the kidney exchange program. Every effort is made to ensure that infectious diseases or cancer are not transmitted to kidney and pancreas recipients. Although very rare, every donor has the ability to transmit infectious disease and/or cancer to the recipient even when preventative testing is negative. There is no testing in the world that is 100% accurate. If a donor tests negative for an infectious disease but is identified to have risk criteria to potentially transmit HIV, Hepatitis B, or Hepatitis C, you'll be notified prior to transplant. Examples of risk criteria include a donor whose medical history is not available, recent jail time, history of IV drug use, and history of sexual promiscuity. This list is not all-inclusive. The risk of transmission if you choose to accept an organ identified as having risk criteria is low. A donor that has risk criteria for transmission of HIV, Hepatitis B, or Hepatitis C is a donor who has tested negative for infectious disease but meets risk criteria identified by the Center for Disease Control. It is not held against you if you turn down an organ offer that is identified as having risk criteria. At this time, you'll be given the option to receive kidney offers from donors with active Hepatitis C. Should you accept, your blood work will be monitored to determine when you might acquire Hepatitis C and in the event that you do, start you on a course of effective treatment. If you have more questions about an organ with risk criteria, you should talk with your nephrologist or surgeon. The average wait time for a deceased donor kidney transplant at Ohio State is approximately 15 months. However, wait time can vary depending on a patient's blood type. Also, sensitized patients, meaning patients with a lot of antibodies in their blood that can cause organ rejection, should expect a longer wait time prior to transplant. With our ability to transplant high KDPI kidneys and Hepatitis C positive organs, wait times for a kidney transplant at Ohio State are below the national average with excellent patient outcomes above the national average. While you are on the kidney transplant wait list, it is important for you to keep your contact information updated as well as notify us of any recent health status changes including hospital stays, surgeries, infections, and changes with your dialysis. Also, maintain a healthy lifestyle by staying active, quit smoking, maintain a healthy weight, and continue to see your primary care physician and nephrologist. While you are on the wait list, evaluation and testing will be ongoing. You'll have blood drawn monthly to check antibody levels and tissue matching, also called cross-matching, with any potential donors. You may also need additional testing and appointments with the transplant center depending on your age and health history. If you miss testing appointments, your status on the transplant wait list can be put on hold or removed depending on your risk factors. It is essential that while you are on the wait list, we are able to contact you at all times. Please keep your phone on and return phone calls as soon as possible. It is crucial to have your voicemail set up. If we cannot reach you, we will attempt to call the people listed on your contact list. If we cannot reach you within one hour, we will move on to the next person on the transplant list. We will make every effort to contact you by calling multiple times and calling the names on your contact list. The transplant coordinator that calls you will ask you screening questions about your recent health and report back to the physician. You will also receive directions on where to go to check in for surgery. Please keep in mind that there is a chance the organ may not be usable once it arrives to the hospital and you may be sent home. Ideally, surgery is performed as soon as the organ is available. However, using the latest perfusion techniques, we are able to transplant kidneys up to 48 hours after organ recovery. The surgery generally lasts approximately four hours and you'll be given general anesthesia and a breathing tube so you won't be awake during the surgery. For kidney transplant surgery, the surgeon will make a six to eight inch incision on your lower abdomen where it is easiest to connect the kidney to important blood vessels and your bladder. Putting the new kidney on your abdomen also makes it easier to take care of any problems that might arise. Your original kidneys are not removed except in unique circumstances. When transplantation is complete, the incision is closed with stitches and staples. For kidney, pancreas, and pancreas transplantation, a six to eight inch incision will be made in the center of your lower abdomen. Usually, the donor pancreas is placed on the lower right side and the donor kidney on the lower left side. Your existing pancreas will not be removed as it will continue to aid in digestion. When transplantation is complete, the incision is closed with stitches and staples. After your incision is closed, your breathing tube will be removed and then you'll be transferred to the recovery unit. We want you to be prepared for this environment and know what to expect. When you wake up from anesthesia, you will have multiple IV lines hooked up to your body. A urinary catheter will be in place so that you don't have to get up to use the bathroom. You'll also have telemetry lines to monitor your vital signs. You will be in the recovery unit for approximately two hours and will have constant interaction with care team members. When you are fully awake, you will be moved to the transplant unit at 10 Rhodes Hall within University Hospital for more private recovery. Since transplant patients take immunosuppressant medicines, the transplant unit is considered a special environment with rules enforced to prevent the spread of infection. Children under 12 years of age will not be allowed on the floor. Live flowers and plants are also not permitted. Your hospital stay could be three to seven days, depending on complications and how you are healing. The majority of your time in the hospital is spent learning about your new organ and how to take care of it. It is important that your support person also be present to learn this information. We want you to go home feeling very comfortable and confident about your new kidney and/or pancreas. After you go home from the hospital, you will have weekly appointments at the transplant clinic for the first month, depending on how your body is recovering from surgery. You will meet with your transplant surgeon, transplant nephrologist, and nurse practitioners. After the first four weeks, time between your appointments will gradually be increased to six weeks, nine weeks, and 12 weeks post-surgery. Then four months, six months, nine months, and one year post-surgery. After one year, follow-up appointments will be scheduled yearly. There will also be the opportunity to transition care back to your local nephrologist once you return to stable kidney function. Your support system after transplant is very important to help you learn new medicines, drive you to appointments, and assist with daily tasks. You will not be able to drive and will have lifting restrictions for eight to 10 weeks after surgery. If your physician feels it is safe, after eight to 10 weeks, you may start back on a modified schedule. Your activity will be increased as you can safely tolerate. As stated before, it's very important that you take your anti-rejection medicine. You will take two to three medicines every day for the rest of your life. You cannot skip doses or let your prescription run out. Only your Ohio State transplant doctor or transplant nurse coordinator should adjust your transplant medicine as these changes can cause you to lose your organ. In some cases, only one missed dose can cause a patient's body to start rejecting the organ, even after many years. To ensure that the newly transplanted kidney and/or pancreas continues to work well, you will have frequent blood work to monitor the levels of your immunosuppression medicine. The blood work also shows how your body is reacting to your new organ and helps your doctor identify potential problems before they exist. Generally, your blood work will be drawn twice a week for three months, weekly between months three to six, then twice a month between six months to one year after transplant. After your one-year post-transplant anniversary, blood draws will be only once per month. Thank you for choosing Ohio State's Comprehensive Transplant Center for your kidney and pancreas transplant care. If you have questions about this information, please contact any one of our transplant team members who will be happy to provide the answers for you. We appreciate your attention during this kidney and pancreas transplant education session and look forward to seeing your pinwheel in our annual garden, where every pinwheel represents an organ transplant at Ohio State since our first transplant in 1967, all made possible by those who said yes to organ donation. Thank you. [Text on screen: The Ohio State University Wexner Medical Center] [Music fades]