Time in the hospital is usually shorter for recipients of living donor kidneys than for recipients of deceased donor kidneys. Most recipients stay in the hospital for four to six days. Living kidney donors usually have a shorter hospital stay of two to three days. If the recipient is older, or has had heart trouble, the first 24 hours may be spent in our intensive care unit to allow for closer observation.
Deceased donor transplantation
When the call comes for those waiting for a deceased donor transplant, they need to travel to the Virginia Mason Medical Center Emergency Room quickly and safely. Upon arrival to our emergency department, blood is drawn for the crossmatch, an intravenous infusion (IV) is started, a chest x-ray and ECG will be done and the admission process is started. Usually, the on-call nephrologist will see you in the emergency department to make sure everything is set for the transplant surgery. The timing of the operation will be determined soon after you arrive at the hospital so friends and family can be informed.
Living donor transplantation
For scheduled surgeries from a living donor, check-in occurs with the Surgery Admissions department the morning of the procedure. A nurse will start an IV which will be followed by the initiation of anesthesia. Once under anesthesia, a breathing tube will be inserted to assist breathing while asleep. A urinary catheter will be placed in the bladder to allow it to empty and to monitor urine output during the procedure. The breathing tube will be removed at the end of anesthesia and the urinary catheter in a few days.
Once under anesthesia, a breathing tube will be inserted to assist breathing while asleep. A urinary catheter will be placed into the bladder to allow the bladder to empty and to monitor urine output during the procedure. The breathing tube will be removed at the end of anesthesia and the urinary catheter in a few days. Kidney surgeries generally take three to four hours.
Following surgery, patients move to a holding area called the recovery room for two to four hours until the effects of anesthesia have worn off and vital signs are stable. Surgeons will speak to the donor and recipient family members in the surgery waiting area after the procedure. Family members can check in and out at a hospitality desk for updates. After initial recovery, donors and recipients are transferred to rooms on our transplant unit in the hospital. Family members may visit in regular hospital rooms.
Most of our patients—donors and recipients—are taken to the hospital transplant floor and may have supplemental oxygen from a small tube to help them breathe for the first few hours as they awake from surgery. Nurses encourage and assist in coughing and deep breathing to help decrease the risk of pneumonia. The surgical staff monitors the healing of the incision and supervises the success of the surgical procedure.
Some pain after surgery should be expected. Pain is usually strongest in the first two days and gradually subsides. Donors and recipients are still a bit sore at the time of discharge. Complete recovery from pain will take a number of weeks. Medications are provided to decrease pain. The nurses can give advice on how to manage the expected pain of healing from an operation. Most patients will have a Patient Controlled Analgesia (PCA) machine that allows controlled administration of pain medications through an intravenous infusion (IV) under supervision.
Air powered stockings are fitted to your legs to provide gentle massage for blood circulation. There is a bladder catheter that drains the urine from the bladder and allows us to monitor the new kidney's function. A small soft drain tube may be placed during surgery.
Finally, you will have an intravenous line in the neck to supply needed medicine and fluids. Kidney recipients are usually able to sip liquids and begin to eat on the second day after surgery, although this can vary from person to person. A pancreas transplant recipient is different, as they may not eat solid food for many days. The transplant surgeon decides when it is safe to start eating and taking pills.
It may be longer if there are complications or your doctors decide that it is in your best interest to stay close to the Transplant Center.
The post-transplant period is very complex. You will be given new medications with dosages changing on a frequent (sometimes daily) basis. You will need to be aware of signs and symptoms of rejection and to respond appropriately when they are observed. You may also experience mood swings related to the medications. You will need to identify a support person to:
After discharge from the hospital, some patients have found it easier to stay close to the hospital for a few days even if they have a place to stay around the Puget Sound area.
The two hotels closest to the hospital are the Baroness Hotel and the Inn at Virginia Mason. Both are run by the same management company. Information about availability and fees can be obtained by calling 800-283-6453. The Baroness Hotel has small equipped kitchenettes in each room. The Inn has standard hotel rooms with a public restaurant on the premises. Both are just steps away from the hospital. There are other hotels in the area. Please discuss any special needs you might have, such as wheel chair accessibility, with your social worker.
On average, lodging is close to $3,500-$5,000 for 30 days. Inquire about monthly rates. Food costs will depend on whether or not you and your support person are eating out every day or shopping and cooking. Food expenses can vary considerably. Parking costs are additional. All of these out of pocket costs can be overwhelming. Ask your social worker about fundraising for these and other expenses related to transplant.
Since the donor may be using sick leave or losing income, generally it is assumed that at the time of the evaluation and the surgery, the recipient and/or the recipient's family assists by offsetting expenses associated with the surgeries, such as transportation, lodging, food and parking. This is an important discussion to have with your donor. These expenses are not generally covered by any other means, such as your health insurance. The medical costs of the evaluation and surgery are covered.
If your income is below 300 percent of the Federal Poverty Guidelines, or if you have extenuating circumstances, you may qualify for assistance to cover these expenses for your donor through the National Living Donor Assistance Center (NLDAC). Please discuss this with your social worker.
Each day brings better kidney function and steady recovery from the operation. While in the hospital, you learn about your new medications. Pharmacists will visit you to clarify your medication list in bedside teaching sessions with instructional videos. Family members are encouraged to learn along with you. The tubes are removed one by one. Our goal is for patients to leave the hospital with as few extra tubes as possible and eating a normal diet. The bladder catheter is usually removed before discharge from the hospital. Often, you will still have your neck IV line for several doses of medication outside the hospital before it is removed.
You should be aware of a tube called a "ureteral stent." It is not used in every case, and it is invisible from the outside. It helps the transplanted kidney recover from surgery. If present, the stent should be removed within six weeks after surgery by a short non-operative procedure in the transplant surgeon's office. If left in place, the stent may cause kidney stones or infections. Before you leave the hospital, we will make sure you know you have a ureteral stent and that you schedule an appointment to have it removed. It never hurts to ask your nurses and doctors if you have a stent that needs to be removed.
You are supplied with a special medication box to help with organizing and dispensing your new prescriptions, as well as detailed pages of instructions and guidelines to follow. These instructions and guidelines are to be discussed with the transplant nephrologist on each office visit after leaving the hospital so always bring them to your doctor appointments.
You will have an appointment with the surgeon within seven to ten days following discharge. After surgery, you will need more frequent visits with a nephrologist to monitor the function of the transplanted kidney.
During all appointments, the incision will be assessed for healing. Guidelines for returning to usual activities will also be discussed at this visit. Kidney donors are advised to have an annual physical exam.