Preparing and Waiting
for a Kidney Transplant
Clear information for you and your whānau during assessment and while waiting for a kidney.
Useful throughout your transplant journey
A 30-second introduction
Prototype video for internal review. Not approved for patient use.
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Your transplant journey
Kidney transplantation involves several stages. Select the stage that feels most relevant to you now.
Contents
Select a chapter to go directly to that section.
Meet your healthcare team
Kidney transplantation involves a team of healthcare professionals. Each person has a different role in preparing you for transplantation, caring for you in hospital and supporting you afterwards.
Select a team below, then select an individual team member to learn more about how they may be involved in your care.
Renal transplant coordinators Your main point of contact during assessment and while waiting for a transplant.
The Auckland renal transplant coordinators help guide patients and whānau through assessment, the waiting list and preparation for transplantation.
PK Peta Kelly Renal transplant coordinator
Peta is one of the renal transplant coordinators at Auckland Hospital. She helps guide patients through assessment, the waiting list and preparation for transplantation.
When you may meet her
During transplant assessment, while you are on the waiting list and when preparing for transplantation.
How she may help you
She may organise assessments, tests and appointments, explain the transplant process and help answer practical questions.
What you can discuss
Changes in your health, contact details or availability, and questions about assessment, waiting or preparation.
AR Ann Rudolph Renal transplant coordinator
Ann is one of the renal transplant coordinators at Auckland Hospital. She helps coordinate appointments and supports patients and families through the transplant process.
When you may meet her
During assessment, while waiting for a transplant and during preparation for admission.
How she may help you
She may help organise appointments, explain next steps and keep you connected with the transplant service.
What you can discuss
Appointments, tests, changes in your circumstances and questions about the transplant pathway.
HD Helen Drummond Renal transplant coordinator
Helen is one of the renal transplant coordinators at Auckland Hospital. She helps patients through assessment, preparation and ongoing contact with the transplant service.
When you may meet her
During assessment, preparation and while you are active on the transplant waiting list.
How she may help you
She may coordinate care and help you understand what needs to happen before transplantation.
What you can discuss
Test results, appointments, changes in your health and any concerns about staying ready for transplantation.
HW Helen Whitehouse Renal transplant coordinator
Helen is one of the renal transplant coordinators at Auckland Hospital. She supports patients and living kidney donors and helps coordinate care before transplantation.
When you may meet her
During transplant assessment and while preparing for living or deceased donor transplantation.
How she may help you
She may coordinate appointments, explain the process and support communication between you and the transplant team.
What you can discuss
Practical questions, changes in your health and concerns about preparing for transplantation.
KL Karyn Lowe Renal transplant coordinator
Karyn is one of the renal transplant coordinators at Auckland Hospital. She helps organise care and supports patients and donors through the transplant pathway.
When you may meet her
During assessment, preparation and while waiting for transplantation.
How she may help you
She may organise care, provide information and help you understand your next steps.
What you can discuss
Appointments, investigations, changes in circumstances and questions about the transplant process.
LB Leela Byun Renal transplant coordinator
Leela is one of the renal transplant coordinators at Auckland Hospital. She helps patients prepare for transplantation and stay connected with the transplant team.
When you may meet her
During assessment, waiting-list follow-up and preparation for transplantation.
How she may help you
She may help coordinate your pathway and answer practical questions about preparing for transplantation.
What you can discuss
Your appointments, availability, health changes and questions about what happens next.
AG Andrea Guo Renal transplant coordinator
Andrea is one of the renal transplant coordinators at Auckland Hospital. She helps patients through the practical and clinical steps involved in preparing for transplantation.
When you may meet her
During assessment, while waiting and when preparing for a possible transplant admission.
How she may help you
She may help coordinate investigations and appointments and explain what you need to do.
What you can discuss
Health changes, contact details, availability and questions about your transplant pathway.
Renal transplant physicians Doctors who assess and manage your kidney and transplant health.
Renal transplant physicians, also called transplant nephrologists, assess your medical suitability for transplantation and manage your kidney health before and after the operation.
PM Paul Manley Renal transplant physician
Paul is a renal physician at Auckland City Hospital. He helps assess patients for transplantation and manages kidney health before and after transplant.
When you may meet him
During assessment, review appointments, your hospital admission and long-term follow-up.
How he may help you
He may assess your suitability, review medical conditions and manage your kidney health and transplant medicines.
What you can discuss
Medical risks, medicines, test results, kidney function and long-term transplant care.
ID Ian Dittmer Renal transplant physician
Ian is an experienced renal transplant physician. He helps assess patients, manage transplant medicines and monitor kidney function after transplantation.
When you may meet him
During assessment, inpatient care and follow-up after transplantation.
How he may help you
He may assess medical suitability, manage medicines and monitor transplant kidney function.
What you can discuss
Risks, treatment options, medicines, side effects and long-term follow-up.
JA Jafar Ahmed Renal transplant physician
Jafar is a renal physician and transplant nephrologist at Auckland City Hospital. He supports patients through assessment, transplantation and follow-up.
When you may meet him
During assessment, your hospital stay or transplant clinic follow-up.
How he may help you
He may review your kidney health, medical risks, medicines and transplant function.
What you can discuss
Suitability for transplant, medicines, investigations and ongoing care.
LC Louise Crowe Renal transplant physician
Louise is a renal physician in the Auckland renal service. She helps care for patients with kidney disease and people being considered for transplantation.
When you may meet her
During assessment, medical review or follow-up appointments.
How she may help you
She may assess your kidney health and help manage medical conditions before and after transplant.
What you can discuss
Medical suitability, investigations, medicines and ongoing kidney care.
HP Helen Pilmore Renal transplant physician
Helen is a senior transplant nephrologist at Auckland City Hospital. She has extensive experience caring for kidney transplant patients before and after transplantation.
When you may meet her
During transplant assessment, specialist review or ongoing transplant care.
How she may help you
She may assess medical suitability, manage complex kidney problems and monitor transplant health.
What you can discuss
Risks, kidney function, transplant medicines and long-term management.
SH Sophie Harmos Renal transplant physician
Sophie is a renal physician at Auckland City Hospital. She cares for people with kidney disease and supports patients through assessment and follow-up.
When you may meet her
During assessment, inpatient review or follow-up care.
How she may help you
She may review your kidney health, medical conditions and transplant treatment.
What you can discuss
Medical questions, investigations, medicines and ongoing follow-up.
Transplant surgeons Surgeons who assess you and perform the transplant operation.
The transplant surgeons assess the surgical aspects of transplantation, perform the transplant operation and monitor your early surgical recovery.
CM Carl Muthu Transplant surgeon
Carl is a vascular and transplant surgeon at Auckland City Hospital. He is involved in kidney transplantation and also cares for patients who require dialysis access or vascular surgery.
When you may meet him
During surgical assessment, your transplant admission and recovery in hospital.
How he may help you
He may assess surgical suitability, explain the operation, perform transplant surgery and monitor recovery.
What you can discuss
The operation, surgical risks, wounds, drains, recovery and your hospital stay.
MS Markus Schamm Transplant surgeon
Markus is a specialist surgeon involved in kidney transplantation at Auckland City Hospital.
When you may meet him
During surgical assessment, transplantation or your recovery in hospital.
How he may help you
He may assess surgical risks, perform the transplant operation and monitor your early recovery.
What you can discuss
The operation, risks, recovery and any surgical concerns.
TH Tom Hanna Transplant surgeon
Tom is a general and transplant surgeon at Auckland City Hospital. He helps assess patients for transplantation, performs transplant surgery and looks after patients during their early recovery in hospital.
When you may meet him
During surgical assessment, your transplant admission or recovery after surgery.
How he may help you
He may assess surgical suitability, explain the operation, perform transplantation and monitor surgical recovery.
What you can discuss
The operation, surgical risks, recovery, wounds, drains and what to expect in hospital.
Ward 71 nursing team The nursing team caring for you after your transplant.
Ward 71 nurses care for patients during their hospital stay following kidney transplantation.
When you may meet them
During your admission and throughout your recovery following transplantation.
How they help you
Ward nurses monitor your recovery, administer medicines, help manage pain, support mobility and provide education before you leave hospital.
What you can discuss with them
Pain, medicines, wounds, mobility, eating and drinking, discharge planning and concerns during your hospital stay.
Transplant pharmacists Specialists who help you understand and safely manage your medicines.
Transplant pharmacists help you understand your anti-rejection medicines and other treatments.
When you may meet them
During your hospital stay and before you leave hospital after transplantation.
How they help you
Pharmacists explain anti-rejection medicines and other treatments, identify possible interactions and support you to take medicines safely.
What you can discuss with them
Doses, timing, side effects, missed medicines, interactions and how to organise your medicines at home.
Dietitians, physiotherapists and support services Team members who support your nutrition, movement, recovery and wellbeing.
Other healthcare professionals may become involved depending on your individual needs.
When you may meet them
During assessment, while you are in hospital or during follow-up, depending on your individual needs.
How they help you
These team members may help with nutrition, physical recovery, mobility, emotional wellbeing, social support and practical arrangements.
What you can discuss with them
Diet, activity, returning home, work, family support or practical concerns that may affect your recovery.
Understanding transplantation
A kidney transplant can improve health and quality of life for many people with kidney failure, but it also involves major surgery, lifelong medicines and ongoing follow-up.
What is a kidney transplant?
People with advanced kidney failure need treatment to replace some of the work normally done by their kidneys. This may include dialysis or a kidney transplant.
A kidney transplant is an operation in which a donated kidney is placed into your body. The transplanted kidney can remove waste and extra fluid from the blood and perform many of the other functions of a healthy kidney.
Transplantation is not a cure for kidney disease. It is another form of kidney replacement treatment. You will need regular blood tests, specialist follow-up and anti-rejection medicines for as long as the transplanted kidney is working.
What a transplant may offer
Many people experience more freedom from dialysis, fewer food and fluid restrictions and improvements in energy, health and quality of life.
What a transplant requires
Transplantation involves major surgery, lifelong medicines, frequent tests and appointments, and an ongoing risk of complications or loss of kidney function.
Learn more about kidney transplantation
Who may be considered for a kidney transplant?
Many people with advanced kidney failure can be considered for transplantation, but it is not a suitable or safe treatment for everyone.
The transplant team considers whether you are likely to benefit from transplantation and whether the risks of surgery and anti-rejection treatment are acceptable.
This requires a detailed assessment of your health, including your heart, lungs, blood vessels, infection risk, cancer risk, mobility and ability to manage treatment after transplantation.
Avoid using a single test result, age or body-size measurement to explain suitability unless it reflects current approved Auckland transplant policy.
Possible benefits of transplantation
A successful kidney transplant may provide benefits such as:
- freedom from regular dialysis
- improved health and energy for many people
- fewer restrictions on food and fluid
- greater flexibility for work, family life and travel
- improved fertility for some people
- improved quality of life
The benefits differ from person to person. A transplant cannot guarantee that every symptom or health problem will improve.
Risks and limitations
Kidney transplantation involves a major operation. Possible risks include bleeding, infection, blood clots, problems with the blood vessels or urine drainage, and complications related to the anaesthetic or another health condition.
There is no guarantee that the kidney will work immediately or continue working for a particular length of time. Some people need dialysis temporarily after the operation, and some transplanted kidneys eventually stop working.
Anti-rejection medicines reduce the activity of the immune system. This can increase the risk of:
- infection
- some cancers, particularly skin cancer
- diabetes or difficulty controlling blood sugar
- high blood pressure
- other medicine-specific side effects
Your individual risks will be discussed during assessment and again before the operation.
Deceased donor kidney transplantation
A deceased donor kidney comes from a person who has died and whose kidneys have been donated for transplantation.
Patients who are suitable for deceased donor transplantation may be placed on the national waiting list after completing the required assessment and activation steps.
A kidney offer depends on donor availability, compatibility, medical suitability and national allocation rules. It is not possible to predict exactly when a suitable kidney may become available.
Living donor kidney transplantation
A living donor transplant uses a kidney donated by a living person. A person can usually live a healthy life with one kidney, but donation involves major surgery and must be assessed very carefully.
A possible donor undergoes a separate and confidential assessment to protect their health, wellbeing and freedom to make their own decision.
A donor may be a family member, partner, friend or another eligible person. The transplant coordinator can explain how a potential donor can seek information without placing pressure on them.
Detailed information about donor assessment and donation should be placed in the separate living donor information pathway once that resource is developed.
How successful are kidney transplants?
Most transplanted kidneys work successfully, and some continue working for many years. However, outcomes vary between people and between donor kidneys.
The length of time a transplant works can be affected by factors such as donor and recipient health, compatibility, delayed kidney function, rejection, infection, medicine adherence and other health conditions.
The transplant team can discuss the expected benefits and risks in your situation, but cannot guarantee how long a particular kidney will work.
The booklet includes one-year and ten-year transplant survival figures. Updated New Zealand or Auckland data, definitions and references should be approved before numerical results are displayed on the platform.
Lifelong medicines and follow-up
Your immune system is designed to recognise and respond to anything it sees as foreign. This includes a transplanted kidney.
Anti-rejection medicines reduce this immune response. These medicines need to be taken every day, exactly as prescribed, for as long as the transplanted kidney is working.
Regular blood tests and clinic appointments are needed to monitor kidney function, adjust medicines and identify problems early.
Do not stop, change or allow these medicines to run out unless your transplant team has specifically told you to do so.
What are the key things to remember?
These questions are for reassurance only. Your answers are not recorded or sent to the transplant team.
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Your transplant assessment
The assessment helps the transplant team understand whether kidney transplantation is likely to be safe, suitable and beneficial for you.
Why is an assessment needed?
Kidney transplantation involves major surgery and lifelong anti-rejection treatment. The transplant team therefore needs a detailed understanding of your health before making a recommendation.
The assessment looks for health conditions that could increase the risk of surgery, infection, cancer, heart problems or complications after transplantation.
It also helps the team plan the care, treatment and support you may need before and after the operation.
Medical assessment
Tests and specialist reviews help assess your heart, lungs, blood vessels, infection risk, cancer risk and general fitness for surgery.
Practical preparation
The team may also discuss support, transport, housing, work, medicines, whānau needs and your ability to manage follow-up care.
What may happen during your assessment?
Tests are arranged
You may receive appointments, blood-test forms or instructions for tests that need to be arranged through your renal team, GP or another service.
Specialists review your health
You may meet members of the transplant team or other specialists who need to assess a particular health concern.
Results are reviewed
The transplant team reviews the assessment information and decides whether more tests, treatment or discussion are needed.
A decision is discussed
Your renal physician should explain the outcome, what it means and what may need to happen next.
Tests and reviews that may be included
Blood tests and tissue typing
Blood tests are used to assess your general health, blood group, immune system, infection risk and other medical conditions.
Tissue typing and antibody testing provide information that may later be used when assessing compatibility with a possible donor kidney.
Some blood tests may need to be repeated during assessment or while you are waiting.
Infection screening and vaccinations
Anti-rejection medicines reduce the activity of your immune system. The team therefore needs to identify and treat infections before transplantation where possible.
You may need blood tests, urine tests or other investigations to look for infection.
It is important to keep recommended vaccinations up to date before transplantation.
The current vaccination schedule and advice about live vaccines should be reviewed and approved before publication.
Discuss vaccines with your transplant or renal team rather than arranging a live vaccine without checking first.
Urine tests
You may be asked to provide a urine sample to look for infection or another problem that may need treatment.
Follow the collection instructions you are given, as these help reduce the chance of contamination.
Heart and breathing tests
Tests may be used to assess whether your heart and lungs are strong enough for surgery.
These may include:
- a chest X-ray
- an ECG, which records the electrical activity of the heart
- an ultrasound scan of the heart
- an exercise or stress test
- review by a heart or respiratory specialist
The tests needed will depend on your health, symptoms and medical history.
The booklet includes a fixed age threshold for additional heart testing. The platform should instead reflect current Auckland practice and individual clinical assessment.
Dental care
Dental problems can be a source of infection. You may be asked to have your teeth and gums checked and complete any recommended treatment before transplantation.
Continue regular dental care while waiting and tell your transplant team if you develop a dental infection or require major dental treatment.
The platform should explain who arranges the dental assessment and whether any costs are the patient’s responsibility.
Routine health and cancer screening
The transplant team may ask whether routine health screening is up to date.
This can include screening that is appropriate for your age, anatomy, family history and medical history.
You may need to arrange some screening through your GP or the national screening services.
The final platform should use current New Zealand screening terminology, eligibility criteria and contact information.
Surgical review
You may meet a transplant surgeon during your assessment.
The surgeon may review your previous operations, blood vessels, weight, mobility and any issue that could affect how the operation is performed.
This is also an opportunity to ask questions about the operation, wound, recovery and surgical risks.
Weight, nutrition, mobility and fitness
Weight, nutrition, muscle strength and mobility can affect the risks of surgery and recovery.
The team may discuss exercise, nutrition or weight management and may refer you to a dietitian, physiotherapist or another health professional.
These discussions should focus on making transplantation and recovery safer rather than placing blame on you.
The booklet includes a specific BMI threshold. This should not be transferred to the platform until the current Auckland transplant policy has been confirmed.
Practical, social and whānau planning
Transplantation affects more than your medical treatment. The team may discuss your practical circumstances and the support available to you.
This may include:
- who could support you after surgery
- transport to Auckland and follow-up appointments
- accommodation if you live outside Auckland
- work, leave and financial concerns
- care of children, dependants, pets or your home
- cultural, spiritual or language needs
- your ability to manage medicines and appointments
Tell the team early if there is a practical barrier or concern. Social workers, Māori health services, Pacific health services or other support teams may be able to help.
Other specialist reviews
You may need assessment by another specialist if you have a health condition that could affect transplantation.
This could include review by cardiology, respiratory medicine, vascular surgery, infectious diseases, cancer services or another clinical team.
A specialist review does not automatically mean that you cannot have a transplant. It helps the team understand the risk and whether treatment or further testing is needed.
What could the assessment decision be?
Suitable for transplantation
The team may agree that transplantation is an appropriate treatment option and explain the next steps.
More information is needed
Further tests, specialist advice or treatment may be required before a decision can be made.
Not ready at present
A health or practical issue may need to be treated or improved before the assessment can continue.
Transplantation is not recommended
The team may decide that the likely risks are greater than the expected benefit. Your renal physician should explain the reasons and discuss other treatment options.
What are the key things to remember?
These questions are for reassurance only. Your answers are not recorded or sent to the transplant team.
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The waiting list
Being accepted for kidney transplantation and being active on the waiting list are related, but they are not always the same.
From assessment to the waiting list
When your transplant assessment is complete, your renal physician and the transplant team will review the information collected during your assessment.
If kidney transplantation is considered suitable, you may be accepted for the deceased donor waiting list. There may still be further steps before you become active and eligible to be considered when a kidney becomes available.
Accepted
The transplant team has agreed that kidney transplantation is a suitable treatment option for you.
Active
The required steps have been completed and you can be considered when a compatible deceased donor kidney becomes available.
Understanding the waiting list
Accepted and active are not always the same
Being accepted means that transplantation has been agreed as a suitable treatment option.
Becoming active may depend on completing required blood samples, tests or other actions identified by your transplant team.
The team should tell you what remains outstanding and when your status changes.
Tissue-typing blood samples
Tissue typing provides information that helps the transplant team assess compatibility between you and a possible donor kidney.
The current booklet states that a tissue-typing sample is required before activation and that monthly samples are needed to remain active.
The exact frequency, location and process for these blood samples should be confirmed by the Auckland Renal Transplant Group before publication.
Follow the schedule and blood-test instructions given to you by your transplant team.
How kidney matching works
The waiting list is not simply a numbered queue in which the person who has waited longest always receives the next kidney.
When a deceased donor kidney becomes available, several factors are considered. These can include compatibility, blood group, antibodies, medical suitability and allocation rules.
This means another person may receive a kidney before you, even if they joined the waiting list later.
The final description should be checked against the current New Zealand kidney-allocation policy.
Becoming temporarily inactive
There may be times when it is not safe or appropriate for you to receive a transplant. Your waiting-list status may then be changed temporarily.
Possible reasons can include an infection, an operation, a new health problem, incomplete tests or another issue that needs to be reviewed.
Temporary inactivity does not always mean that transplantation is no longer possible. The team should explain the reason, what needs to happen next and whether your status can be reviewed again.
Reviews while you are waiting
Your health and transplant suitability may need to be reviewed again while you are waiting.
The booklet states that patients may be reviewed every one to two years, but the timing can depend on your circumstances and current local practice.
Attend any requested appointments and complete repeat tests when asked.
How long will I wait?
It is usually not possible to predict exactly when a suitable kidney will become available.
Waiting time varies because donor availability and compatibility are different for every person.
Your transplant team can explain the factors relevant to you, but they cannot promise a particular date or waiting time.
What are the key things to remember?
These questions are for reassurance only. Your answers are not recorded or sent to the transplant team.
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Staying ready
While you are waiting, there are practical and health-related steps that can help you remain ready if a suitable kidney becomes available.
Readiness is more than waiting for the phone
The waiting period can be unpredictable. You may wait for months or longer, and your health or circumstances may change during that time.
Staying ready means continuing your kidney care, reporting important changes and keeping practical arrangements up to date.
You do not need to manage everything alone. Your renal team, transplant coordinators, whānau and support services can help you prepare.
Look after your health
Continue dialysis and appointments, take medicines as prescribed and maintain dental care, vaccinations, nutrition and physical activity.
Prepare your practical plan
Keep contact details current and plan transport, support, work, dependants, pets, accommodation and follow-up arrangements.
How to remain ready while you wait
Continue dialysis and kidney appointments
Regular dialysis and renal appointments remain important while you are waiting for a transplant.
These treatments help manage your health and allow your renal team to identify changes that may need further review.
Attend dialysis as planned and speak with your renal team if you are having difficulty completing treatments or attending appointments.
Keep your contact details current
A kidney offer can occur at any time of the day or night. The transplant team needs to be able to reach you quickly.
Tell the transplant coordinators if any of the following change:
- your mobile or home telephone number
- your address
- your support person’s contact details
- where you are staying
- how you prefer the team to contact you
Keep your telephone charged and check that calls from unknown numbers are not automatically blocked.
Report important health changes
Your transplant team needs current information about your health so they can decide whether transplantation remains safe.
Contact the team if you have an important change such as:
- a significant infection or fever
- a hospital admission
- an operation or planned procedure
- a new heart, breathing or circulation problem
- a new diagnosis
- antibiotics or an important change in medicines
- a change in mobility or general health
The Auckland Renal Transplant Group should confirm the final reporting instructions and any after-hours contact process.
Smoking and vaping
Smoking increases the risk of heart disease, lung problems, infection, poor wound healing and some cancers.
If you smoke, ask your renal team or GP about support to stop. Stopping can improve your general health and reduce the risks of surgery.
The final platform should reflect the Auckland transplant service’s current smoking and vaping policy.
Dental care and vaccinations
Regular dental care helps reduce the risk of infection from teeth or gums.
Continue dental checks and tell your transplant team if you develop a dental infection or need major dental treatment.
Keep recommended vaccinations up to date before transplantation. Ask the transplant or renal team before receiving a live vaccine.
The final schedule, links and live-vaccine advice should be approved before publication.
Physical activity and fitness
Maintaining strength and fitness can help with recovery after surgery.
Walking or another activity suited to your health and mobility can be helpful. Build activity gradually and follow advice from your renal team, physiotherapist or another health professional.
Tell the team if your mobility, balance, breathing or ability to exercise changes significantly.
Nutrition and weight
Good nutrition, muscle strength and weight stability can affect your health before surgery and your recovery afterwards.
Follow the individual diet and fluid advice provided by your renal or dialysis team. This advice may differ from general healthy eating guidance because of your kidney condition.
Ask for help if eating, appetite, weight loss or weight gain is becoming difficult to manage.
Do not add a fixed BMI threshold until the current Auckland transplant policy has been clinically approved for publication.
Choose your support person
A support person can help with travel, communication, practical arrangements and recovery after discharge.
Discuss the following with them before a kidney offer occurs:
- how they can be contacted at any time
- whether they can travel with you or meet you in Auckland
- what responsibilities they may need to help manage
- transport after discharge
- transport to early clinic appointments
The booklet describes a support person being required for two weeks and possibly up to one month. The final duration and wording should reflect current Auckland practice.
Transport and accommodation
Make a plan for how you would travel to Auckland City Hospital if you received a call during the day, overnight or on a weekend.
Consider:
- who will drive or travel with you
- how long the journey may take
- what you will do if your first transport option is unavailable
- parking or drop-off arrangements
- accommodation if you live outside Auckland
- transport home after discharge
- transport for frequent follow-up appointments
Tell the transplant coordinators or social worker if transport or accommodation may be difficult.
Work, dependants, pets and your home
A sudden hospital admission may affect responsibilities at home or work.
Plan who could help with:
- children or other dependants
- pets
- your home and security
- work or study commitments
- financial or benefit concerns
- regular bills or household tasks
Keep important contact details together so your support person can use them if needed.
Medicines list and hospital bag
Keep an up-to-date list of your regular medicines, including the dose and when you take each one.
A small hospital bag can be prepared in advance. It may include:
- comfortable loose clothing
- basic toiletries
- glasses, hearing aids or mobility equipment
- your phone and charger
- important contact details
- your medicines list
Avoid bringing valuables or large amounts of personal belongings.
Travel while you are waiting
Tell the transplant team if you are planning to travel or will be difficult to contact.
Ask whether your waiting-list status or contact arrangements need to change while you are away.
Make sure the team knows how to reach you and when you expect to return.
What are the key things to remember?
These questions are for reassurance only. Your answers are not recorded or sent to the transplant team.
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You cannot control when a kidney becomes available, but there are practical steps that can help you remain well and ready for transplantation.
When the team calls
A possible kidney offer may come at any time. Knowing what to say, what to write down and what to do next can make the call easier to manage.
Be prepared before the call comes
Review this list now and return whenever your circumstances change. Tick the items you have prepared.
A call means there may be a kidney for you
The transplant team may call when a deceased donor kidney could be suitable for you. The caller will check your current health, explain what you need to do and tell you whether to come to hospital.
The call does not guarantee that the transplant will proceed. Further compatibility tests, medical checks and assessment of the donor kidney are still needed.
Listen and answer honestly
Tell the caller about illness, infection, treatment, medicines, hospital visits or anything else that may affect your safety.
Write down the instructions
Record what you should do about eating, drinking, dialysis, medicines, travel and where to report at the hospital.
What to do when the phone rings
Move somewhere you can concentrate
Sit down if possible. Use speakerphone only if you are comfortable with another person hearing your health information.
Have a pen or your phone notes ready
Write down the caller’s name, the time of the call and every instruction you are given.
Answer the health questions honestly
Even a minor symptom or recent treatment may be important. Sharing it does not automatically mean the transplant cannot proceed.
Repeat the instructions back
Confirm what you should do next, where you should go and when you are expected to arrive.
Call back if something changes
Contact the team promptly if you become unwell, cannot follow the instructions or will be delayed.
Important information for the call
Health information to tell the caller
Tell the caller if you currently have, or have recently had:
- fever, chills or another sign of infection
- cough, sore throat, breathing symptoms or chest pain
- vomiting, diarrhoea or difficulty eating and drinking
- a wound, skin infection or dental problem
- antibiotics or treatment for an infection
- a hospital admission or emergency department visit
- an operation, procedure or new diagnosis
- a blood transfusion
- an important change in your general health or mobility
This list is not exhaustive. Tell the caller about anything you think may be relevant.
The transplant service should confirm the final screening questions asked during a kidney-offer call.
Medicines
Tell the caller about all medicines you are currently taking, including:
- regular prescription medicines
- blood-thinning medicines
- insulin or diabetes medicines
- antibiotics
- medicines prescribed by another doctor
- over-the-counter medicines
- herbal, traditional or complementary products
Ask what to do with medicines due before you reach hospital and follow the specific advice given during the call.
Food and drink instructions
The caller will tell you what to do about eating and drinking.
Do not rely on a previous kidney-offer call or general advice, because the instruction may differ depending on timing and your circumstances.
If you have recently eaten or drunk something, tell the caller honestly what you had and when. Do not withhold this information.
Dialysis instructions
Tell the caller:
- which type of dialysis you use
- when your last dialysis treatment occurred
- when the next treatment is due
- whether there were any recent problems with dialysis
- your current access type, such as a fistula, graft or catheter
The team will tell you whether to continue, delay or change the planned dialysis treatment.
Follow the specific dialysis instruction given by the transplant or renal team.
What to bring to hospital
Bring only essential items. These may include:
- your current medicines list
- medicines or dialysis information requested by the team
- photo identification if available
- glasses, hearing aids and their cases
- walking aids or other essential equipment
- comfortable, loose clothing
- basic toiletries
- your phone and charger
- important support-person contact details
Avoid bringing valuables, jewellery or large amounts of personal property.
The transplant service should confirm whether patients are asked to bring their medicines, dialysis equipment or any additional admission documents.
Travel and unexpected delays
Tell the caller where you are and how long you expect the journey to take.
If you cannot travel immediately, your transport arrangement changes or you are delayed:
- contact the transplant team promptly
- explain what has happened
- give an updated arrival time
- follow any new instruction
Do not rush or drive unsafely. Keep the team informed rather than taking unnecessary risks.
Why the transplant may not proceed
The call means that a kidney may be suitable, not that the operation is certain.
The transplant may not proceed if:
- the final compatibility testing is not satisfactory
- the kidney is found not to be suitable
- a new health concern is identified
- the risks are considered too high at that time
- another clinical or allocation issue arises
This can be deeply disappointing. It does not necessarily mean that you are no longer active or cannot receive another kidney offer in the future.
Involving your support person
After you have spoken with the transplant team, contact your support person and explain:
- that you have received a possible kidney offer
- where and when you need to go
- what help you need with transport or responsibilities
- how they can stay updated
A support person can help you check that you have understood the instructions and have the essential items you need.
What are the key things to remember?
These questions are for reassurance only. Your answers are not recorded or sent to the transplant team.
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Coming to hospital
When you arrive at Auckland City Hospital, further tests and reviews are needed before the transplant operation can be confirmed.
What happens when you arrive?
Follow the instructions given during the transplant call. You will be told where to report and what time you should arrive.
After admission, the team will review your health, repeat important tests and continue assessing the donor kidney.
There may be periods of waiting while results are completed and the transplant team gathers the information needed to make a final decision.
You are assessed
Staff will confirm your identity, review your current health and ask about illness, medicines, dialysis, allergies and recent treatment.
The kidney is assessed
Compatibility results and information about the donor kidney are reviewed before surgery can proceed.
Your admission journey
Report to the location you were given
Follow the admission instructions from the transplant team. Ask hospital staff for help if you are unsure where to go.
Meet the admitting team
Nurses and doctors will check your identity, ask questions and begin preparing you for possible surgery.
Complete final tests
Blood tests, examination and other investigations may be needed before a final decision is made.
Meet the anaesthetic and surgical teams
They will review the procedure, your individual risks and any questions you or your whānau have.
Wait for the final decision
The operation proceeds only when the final results are satisfactory and the transplant team considers the kidney suitable.
What may happen before surgery?
Where should I go?
The transplant team will tell you where to report when they call. The location may depend on the time of day and current hospital arrangements.
Write down:
- the hospital building or entrance
- the ward or admission location
- the expected arrival time
- the number to call if you are delayed or cannot find it
The final platform should include the approved daytime and after-hours admission locations and directions.
Nursing assessment
A nurse may:
- confirm your identity and personal details
- check your blood pressure, pulse, temperature and weight
- ask when you last ate and drank
- review your medicines and allergies
- ask about dialysis and when it last occurred
- ask again about illness or recent treatment
- prepare you for blood tests and other investigations
You may be asked to change into a hospital gown and remove jewellery, dentures or other items before surgery.
Blood tests and compatibility testing
Blood tests may be taken to assess:
- your blood count
- kidney function and blood chemistry
- blood clotting
- blood group and compatibility
- immune-system information relevant to the donor kidney
- other health or infection concerns
Final compatibility testing helps assess whether your immune system is likely to react strongly against the donor kidney.
The transplant service should approve whether the patient-facing term should be “crossmatch”, “final crossmatch” or another description.
If compatibility testing is not satisfactory, the transplant may not be able to proceed.
Medical and surgical review
A doctor will review your current health and examine you.
They may ask about:
- symptoms since the transplant call
- recent infections, admissions or procedures
- heart, breathing or circulation symptoms
- your dialysis treatment and access
- your regular medicines and allergies
- previous operations or anaesthetic problems
Additional tests may be requested if a new concern is identified.
Anaesthetic review
The anaesthetist is the doctor responsible for your anaesthetic and monitoring during the operation.
They may discuss:
- your previous anaesthetic experiences
- heart, lung and other medical conditions
- allergies and medicines
- how you will be monitored during surgery
- intravenous lines or other monitoring that may be needed
- pain relief after the operation
- anaesthetic risks relevant to you
Tell the anaesthetist if you have had a difficult airway, severe nausea, an allergic reaction or another problem with an anaesthetic in the past.
Dialysis before the operation
Some patients need dialysis before the transplant operation.
This may depend on:
- when your last dialysis treatment occurred
- your blood-test results
- your fluid balance
- the expected timing of surgery
- your individual medical needs
The renal and transplant teams will decide whether dialysis is needed and explain the plan.
The final platform should describe where dialysis occurs and who coordinates it during a transplant admission.
Other tests that may be needed
Depending on your health and the circumstances, the team may request additional tests such as:
- an ECG
- a chest X-ray
- urine tests
- infection testing
- heart or breathing assessment
- another scan or specialist review
Additional testing does not automatically mean that the transplant has been cancelled. It may be needed to make the safest decision.
Consent for the operation
A transplant surgeon will discuss the proposed operation and ask for your consent before surgery.
The discussion should include:
- what the operation involves
- the expected benefits
- important risks and possible complications
- information known about the donor kidney
- the possibility that the kidney may not work immediately
- the possibility that further treatment or surgery may be needed
- the option not to proceed
Ask questions and tell the surgeon if there is anything you do not understand.
Why there may be a long wait
There may be several hours between your arrival and a final decision.
Time may be needed for:
- compatibility testing
- blood tests and medical review
- dialysis
- assessment of the donor kidney
- the retrieval and transport of the kidney
- operating theatre preparation
Waiting can be difficult. Ask staff for an update if you are uncertain about what is happening.
Why the operation may not proceed
The operation may be stopped if the final information suggests that proceeding would not be safe or appropriate.
Reasons may include:
- an unsuitable compatibility result
- a health concern found during admission
- an unexpected problem with the donor kidney
- the risks being considered too high at that time
- another clinical or allocation issue
This can be extremely disappointing, particularly after travelling to hospital and completing the admission process.
The team should explain what happened and whether the decision changes your waiting-list status.
Your whānau or support person
Your support person may help you:
- remember information and questions
- communicate with whānau
- manage transport and responsibilities
- prepare for your recovery and discharge
Hospital access for support people may depend on the time of day, ward arrangements and clinical circumstances.
Tell staff who you would like updated and whether there are cultural, language or communication needs that should be considered.
What are the key things to remember?
These questions are for reassurance only. Your answers are not recorded or sent to the transplant team.
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The operation
During the operation, the donated kidney is placed in the lower part of your abdomen and connected to your blood vessels and bladder.
How is the transplant performed?
The operation is performed under a general anaesthetic. This means you will be asleep and will not feel the surgery.
The transplant surgeon makes an incision in the lower part of your abdomen. The donated kidney is usually placed in either the right or left side of the pelvis.
The kidney’s blood vessels are joined to blood vessels in your pelvis. The ureter, which is the tube carrying urine from the kidney, is joined to your bladder.
The kidney is placed
The donated kidney is positioned in the lower abdomen rather than in the usual position of your original kidneys.
The connections are made
The kidney is connected to your blood supply and its ureter is joined to your bladder so urine can drain normally.
What happens during the operation?
You are given a general anaesthetic
The anaesthetic team monitors you throughout the operation and manages your breathing, circulation, fluids and pain relief.
An incision is made in the lower abdomen
The incision is usually curved and positioned over the right or left side of the pelvis.
The kidney’s blood vessels are connected
The donor artery and vein are joined to blood vessels in your pelvis so blood can flow through the transplanted kidney.
The ureter is connected to the bladder
This allows urine made by the transplanted kidney to pass into your bladder.
The wound is closed
The surgeon checks the kidney and surgical area, places any required tubes or drains and closes the incision.
Learn more about the operation
Where is the transplanted kidney placed?
Your original kidneys sit higher in the back of the abdomen.
A transplanted kidney is usually placed lower down in the pelvis, close to the blood vessels and bladder to which it will be connected.
The surgeon decides which side to use after considering your anatomy, previous operations, blood vessels and other clinical factors.
What happens to my original kidneys?
Your original kidneys are usually left in place because removing them would add another operation and is not normally needed.
Removal may sometimes be considered if an original kidney is causing a particular problem, such as:
- repeated infection
- significant bleeding
- severe pain
- very large kidneys that limit space
- a suspected or confirmed cancer
- another condition requiring surgical treatment
Your surgeon will discuss this separately if it applies to you.
The incision and wound
The incision is usually in the lower part of the abdomen and may curve towards the groin.
The wound may be closed using stitches, clips, surgical glue or another technique. The team will explain how it has been closed and whether anything needs to be removed later.
Swelling, bruising and discomfort around the wound are common in the early recovery period.
The final wording should remain broad unless the Auckland transplant service confirms a standard wound-closure practice.
Ureteric stent
A small internal tube called a ureteric stent may be placed across the join between the transplant ureter and your bladder.
The stent supports urine drainage while the join heals. It is internal, so you will not usually see it.
If a stent is used, it normally needs to be removed later using a short procedure. The transplant team will explain when and how this will happen.
The service should confirm whether stents are routinely used and the usual removal process before adding fixed timing.
Urinary catheter
A urinary catheter is a soft tube placed through the urethra into the bladder.
It drains urine into a bag and allows the team to measure urine production accurately after surgery.
The catheter also helps keep the bladder decompressed while the ureter-to-bladder join begins healing.
It is removed when the team considers it safe to do so.
Surgical drain
A drain is a soft tube that may be placed near the transplanted kidney and brought out through the skin.
It allows blood or other fluid to drain from the surgical area and helps the team monitor what is collecting around the kidney.
Not every patient requires a drain. If one is used, it is removed when the amount and type of fluid are considered satisfactory.
Avoid describing drains as routine unless this reflects approved local practice.
Intravenous lines and monitoring
You will have one or more intravenous lines for fluids, medicines and blood tests.
Depending on your health and the anaesthetic plan, you may also have:
- an arterial line to monitor blood pressure closely
- a larger intravenous or central line
- oxygen
- heart and oxygen monitoring
These are removed when they are no longer needed.
Peritoneal dialysis catheter
A peritoneal dialysis catheter is sometimes called a Tenckhoff catheter.
The decision to leave it in place or remove it depends on your circumstances, the operation and the likelihood that dialysis may still be required.
Your surgeon and renal team will explain the plan for your catheter.
The final content should reflect current Auckland practice about removal during transplantation or at a later procedure.
Dialysis fistula or graft
A haemodialysis fistula or graft is not normally removed during the transplant operation.
It may still be needed if the kidney takes time to begin working or if dialysis is required again in the future.
Continue protecting the access and follow the instructions given by your dialysis and transplant teams.
Ultrasound of the transplanted kidney
An ultrasound scan may be used after surgery to look at:
- blood flow into and out of the kidney
- the kidney’s appearance
- urine drainage
- fluid collecting around the transplant
Further scans may be needed if the kidney is not working as expected or if the team has another concern.
The transplant service should confirm whether a routine postoperative ultrasound is performed for every patient and when it usually occurs.
How long does the operation take?
The length of the operation varies. Time is also needed before and after surgery for the anaesthetic, monitoring and transfer to the recovery area.
Your whānau may therefore wait longer than the operating time itself before receiving an update.
A typical operating-time range should be added only after it has been confirmed and approved by the Auckland transplant surgeons.
Surgical risks
Kidney transplantation is major surgery. Possible complications include:
- bleeding
- infection
- blood clots
- problems with blood flow to or from the kidney
- urine leakage or blockage
- fluid collecting around the transplant
- wound complications
- complications affecting the heart, lungs or another organ
- the need for another procedure or operation
- loss of the transplanted kidney
Rarely, severe complications can be life-threatening. Your surgeon and anaesthetist will discuss the risks most relevant to you before you give consent.
What are the key things to remember?
These questions are for reassurance only. Your answers are not recorded or sent to the transplant team.
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Early recovery and what happens next
After the operation, the transplant team will monitor you closely, manage your recovery and help you learn how to care for your new kidney.
What happens after the operation?
Close monitoring
You will be cared for in a closely monitored area after surgery. The team will regularly check your blood pressure, blood tests, fluid balance, pain and how much urine the new kidney is making.
Lines and tubes
You will usually wake with a urinary catheter and intravenous lines. You may also have other tubes or monitoring equipment. These are removed when the team decides they are no longer needed.
Moving, eating and drinking
The nursing and physiotherapy teams will help you begin moving safely. Eating, drinking and activity are gradually increased as your recovery allows.
Learning before discharge
Before leaving hospital, you will begin learning about your medicines, appointments and how to look after yourself and your transplant.
Learn more about early recovery
Pain relief and your wound
The team will provide pain relief and ask you regularly about your comfort. Tell your nurse if your pain is not well controlled or if it is preventing you from moving or breathing comfortably.
Your wound will usually be in the lower part of your abdomen. Loose, comfortable clothing can be easier to wear while the wound is healing.
How the new kidney is monitored
The team will use blood tests, urine measurements and clinical examinations to monitor your kidney.
An ultrasound scan may be used to look at the transplant, the area around it and the blood flow into and out of the kidney.
If the kidney is not working as expected, further tests may be needed. This can include a kidney transplant biopsy.
Rejection
Your immune system naturally recognises the transplanted kidney as different. Anti-rejection medicines reduce this response.
Rejection may be suspected if blood-test results change. A biopsy may be needed to confirm the cause. Many episodes of rejection can be treated, particularly when identified early.
This is one reason why medicines, blood tests and clinic appointments are so important.
Other problems the team watches for
Complications can occur after any major operation. Following a kidney transplant, the team also watches for:
- infection
- bleeding or fluid collecting near the kidney
- problems with urine drainage, including blockage or leakage
- problems with blood flow to or from the kidney
- side effects from medicines
Further scans, procedures or another operation are sometimes needed. Your team will explain any concern and the treatment being recommended.
Anti-rejection medicines
You will need medicines that reduce the activity of your immune system and help prevent rejection.
Do not stop them, change the dose or allow them to run out unless your transplant team has specifically told you to do so.
Before discharge, the pharmacist and transplant team will explain:
- the names and doses of your medicines
- when and how to take them
- important side effects
- what to do if you miss a dose or become unwell
- which other medicines or supplements may be unsafe
How long will I stay in hospital?
Many people remain in hospital for several days. Some need a longer stay because of delayed kidney function, another health problem or a complication.
Your discharge date will depend on your recovery, the function of your kidney, your medicines and whether it is safe for you to continue recovering outside hospital.
Follow-up after leaving hospital
Clinic visits and blood tests are very frequent in the early period after transplantation. The exact schedule depends on your recovery and where you live.
Before your operation, it is helpful to plan for:
- transport to and from appointments
- someone to support you after discharge
- accommodation in or near Auckland if required
- time away from work and other responsibilities
Your transplant team will give you your individual appointment schedule before discharge.
What are the key things to remember?
These questions are for reassurance only. Your answers are not recorded or sent to the transplant team.
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