Questions to Ask Your Transplant Team Before Agreeing to an ABO-Incompatible or Swap Kidney Transplant

Medicine Made Simple Summary

Deciding on an ABO-incompatible or swap kidney transplant can feel overwhelming, especially when you are already dealing with the stress of kidney failure. Asking the right questions helps you understand risks, success rates, timelines, preparation steps, and long-term expectations. This article gives you clear, simple and practical questions to ask your transplant team before saying “yes” to either procedure. These questions will help you feel confident, make the right decision for your health, and ensure you choose a safe, experienced centre for your transplant journey.

Why Asking the Right Questions Matters

Both ABO-incompatible and swap transplants have excellent outcomes when done in experienced centres, but they involve specific steps that families must fully understand. Asking the right questions helps you:

• Understand whether the procedure is right for you

• Avoid unexpected costs or complications

• Plan for hospital stay, recovery and long-term care

• Feel confident and prepared
  Your transplant team expects these questions, and good centres will answer them clearly and patiently.

Start with the Basics: Understanding Your Exact Mismatch

Before deciding on the procedure, ask your doctor:

• What type of mismatch do I have—blood group mismatch, positive crossmatch or both?

• What are my antibody levels (titres)?

• How serious is the mismatch?

• Can the mismatch be corrected?
  Understanding the mismatch helps you know whether ABO-incompatible transplant, swap transplant, or both are suitable.

Key Questions About ABO-Incompatible Kidney Transplant

1. Am I a good candidate for ABO-incompatible transplant?

Your doctor will consider your antibody levels, donor match, overall health, and risk profile. If your titres are extremely high, ABO-incompatible transplant may be difficult or require many sessions of plasmapheresis.

2. How many plasmapheresis sessions will I need?

Different patients need different preparation depending on their antibody levels. Ask your team how long this could take and what you should expect during the procedure.

3. Will I need rituximab?

Rituximab helps reduce B-cells that produce antibodies. Understanding whether you need this injection, when it will be given, and its cost is important.

4. What extra risks does ABO-incompatible transplant carry?

While outcomes are excellent, this procedure may include risks such as:

• Antibody rebound

• Higher infection risk

• Increased immunosuppression

• Possible need for extra plasmapheresis
  Knowing this upfront helps you prepare mentally and financially.

5. What will be the total expected cost?

Ask for a clear breakdown including:

• Plasmapheresis

• Filters

• Rituximab

• Hospital stay

• ICU care

• Surgery

• Post-transplant tests
  Make sure to check whether your health insurance will cover these items.

Key Questions About Swap Transplant

1. How will the hospital match us with another family?

Swap transplant depends on matching blood groups and crossmatch compatibility. Ask how long matching usually takes and how many pairs your hospital has handled.

2. What is the legal approval process?

Swap transplant requires authorization under the THOTA Act. Clarify:

• What documents are needed

• How long approval takes

• Whether all families must attend interviews together

3. What happens if the other family has a medical delay?

All surgeries must happen on the same day. Ask what backup plans exist if one donor develops a temporary issue.

4. What risks are unique to swap transplant?

Medical risks are similar to regular transplants, but logistical risks include scheduling delays or chain breakdowns if one donor cannot participate.

5. What will be the total cost?

Swap transplants are generally more affordable than ABO-incompatible procedures. Ask for a clear written estimate of all expenses.

Questions About the Hospital and Team’s Experience

1. How many ABO-incompatible and swap transplants do you perform per year?

High-volume centres usually have better outcomes due to experience and established protocols.

2. What are your success rates?

Ask specifically for:

• One-year kidney survival

• Five-year kidney survival

• Infection rates

• Rejection rates
  These numbers help you compare different hospitals.

3. Do you have a dedicated transplant coordinator?

A coordinator makes the process smoother, especially for swap transplants and insurance approvals.

4. How experienced is the surgeon with complex transplants?

You may ask how many years they have been doing this surgery and how many ABO-incompatible cases they have handled personally.

Questions About Preparation Before Surgery

1. What tests do I need?

Ensure you understand the timeline for:

• Crossmatch

• Antibody titre

• CT scan for donor

• Viral screening

2. How should I prepare physically?

Ask about diet, exercise, dialysis schedule changes and whether you need vaccinations.

3. Do I need to adjust any medicines I am currently taking?

Some blood pressure medications or blood thinners may need adjustment.

Questions About the Surgery Itself

1. How long will the surgery take for both donor and recipient?

Most transplants take 3–5 hours, but technique and patient condition may affect timing.

2. What type of anaesthesia will be used?

Understanding this helps reduce anxiety.

3. What are the immediate risks on the day of surgery?

Doctors usually explain bleeding risks, anaesthesia risks and rare complications.

Questions About Recovery and Aftercare

1. How long will I be in the hospital?

ABO-incompatible patients may stay longer due to strict monitoring.

2. What will recovery look like in the first month?

Ask about expected urine output, energy levels, appetite and wound healing.

3. How often will I need follow-up tests?

In the first month, patients may need blood tests several times a week.

4. What precautions should I follow at home?

Ask about hygiene, diet, activity, sleeping arrangements and visitor precautions.

5. What signs of rejection should I watch for?

Doctors usually mention swelling, reduced urine output, fever or pain.

Questions About Long-Term Life After Transplant

• Will I ever need plasmapheresis again?

• Will my antibody levels need lifelong monitoring?

• Can I travel after transplant?

• When can I return to work?

• How long will immunosuppressive medicines continue?

• What lifestyle changes will help protect the kidney long-term?
  These questions help you plan for life beyond the hospital.

Conclusion

If you are considering an ABO-incompatible or swap kidney transplant, prepare a list of questions and schedule a detailed discussion with your transplant team. The right questions can help you choose the safest option, plan your finances, prepare for surgery and understand long-term expectations. A confident, informed patient always has better outcomes. Book a consultation with an experienced transplant centre to start your evaluation today.