Most patients with renal failure can be considered as candidates for kidney transplantation, and a significant number of patients witih diabetes mellitus can be considered for pancreas transplantation. Primary physicians and specialist physicians refer patients to the Transplant Clinic and the team responds to each referral. This referral process can be started with one phone call to the Transplant Office (802-847-4774).

It is important to determine the health status of a potential kidney and/or pancreas transplant recipient. For that reason, a comprehensive process of evaluation is conducted on all candidates for the transplant waiting list at Fletcher Allen Health Care. This evaluation typically involves a series of tests conducted by the transplant team. Some of these tests are routinely required before any surgery, while others are targeted directly at kidney or pancreas transplantation. A physical examination and history review would be conducted, as would laboratory tests, chest X-rays and Electrocardiogram.

During the evaluation stage, potential candidates would meet with nurse coordinators, a social worker, a nutritionist, and a financial counselor. The financial counselor would review methods of payment available for kidney transplant and answer any financial questions of the transplant candidate.

The patient's candidacy for transplant is carefully reviewed by the transplant team. The Transplant Selection Committee reviews all the data about one's candidacy and a recommendation about listing this candidate will be made. Once a candidate is accepted for transplantation, they are listed with the Center for Donation & Transplant and their name is added to regional and national lists of the United Network for Organ Sharing (UNOS). The allocation of organs is based on a point system which takes into account medical urgency, time on the waiting list and blood type compatibility. Because donor organs are in short supply, candidates may be on the wait list for two years or longer. An exception to this rule involves organ donation from a living donor. The identification of possible living donors is an important part of the pre-transplant screening process. This possibility is thoroughly explored by the transplant team in close coordination with the patient and with the potential living donor.

Patients are supported and comforted by the knowledge that nurse coordinators are available to them 24 hours a day throughout their participation in the Fletcher Allen Health Care Transplant Program. Professional nurse coordinators are key members in the care and support of all transplant candidates and patients at Fletcher Allen Health Care.

When a compatible kidney and/or pancreas becomes available through the organ bank, the transplant patient is immediately contacted by a nurse coordinator and admitted to Fletcher Allen Health Care Hospital. In the case of a living donor, the transplant procedure can actually be scheduled in advance. Upon admission, a history is taken to update the team's knowledge on the patient's current medical condition and suitability for transplant. Appropriate testing ensures the patient's readiness for surgery.

The actual kidney transplant surgery takes about three hours and about six hours if a pancreas transplant is also being performed. Post-surgery, the patient is transferred to the post-anesthesia recovery room. Once discharged from the recovery room, the patient will be transferred to Surgical Intensive Care Unit or to a Surgical inpatient unit.

The transplant patient begins their new life after transplant by returning home and visiting the Outpatient Clinic three times each week for the first month after discharge from hospital. A series of tests, including blood tests, are conducted to closely monitor the patient's progress. During this initial post-hospital time, patient medications are adjusted to reach a point of maximal stability. Once this initial period is over, patient visit schedules are adjusted to meet their needs.

The Fletcher Allen Health Care Transplantation Staff works to assist transplant recipients as they resume their lives and activities. While Transplantation does much to improve the patient's life, the transplant recipient finds they have an ongoing responsibility to sustain these benefits for the rest of their lives. Transplant patients are active participants in preserving and maintaining their own health. Twice a day, they must log their temperature, pulse rate and weight and bring this information with them each time they visit the Outpatient Clinic.

The widespread success of transplant surgery is due in no small part to the development of immunosuppressive drugs. These drugs inhibit the body's immune system from identifying and rejecting the new organ as "foreign". All patients must take immunosuppressive medication for the rest of their lives following transplant. All the work involved in achieving a successful transplant can be undone very quickly by the failure of patients to take their medications appropriately and responsibly.

The Transplant Team at Fletcher Allen Health Care will be available at all times to assist transplant patients who experience difficulty or risks to the well being of their transplanted organs.

The Transplant Program at Fletcher Allen Health Care in Burlington, Vermont has saved and improved the lives of hundreds of people in recent years through transplant. By replacing organs that have ceased to function effectively, the program has given new life, new energy and new possibilities to people whose lives had previously been restricted by debilitating conditions.