Pre-transplant evaluation: what the tests involve and why
Before any transplant, you go through a detailed evaluation. It has two aims: to find out whether a transplant would be safe and worthwhile for you, and to spot and treat problems early that could put a new organ at risk. Here is what this stage usually involves.
Why is a pre-transplant evaluation needed?
An organ transplant is major surgery followed by lifelong treatment with medicines that weaken the immune system. The transplant team therefore needs to be confident that you can cope with the operation, that there is no hidden infection or cancer that immunosuppression could make worse, and that you will be able to follow the treatment plan afterwards.
The evaluation is not an exam to pass. It is a joint process that often finds and fixes problems – dental decay, undiagnosed heart disease or missing vaccinations, for example – before they become dangerous.
How the process starts
Usually your treating specialist – a kidney, liver, heart or lung doctor – refers you to a transplant centre. In Bulgaria, national waiting list registration and coordination are carried out together with the Executive Agency for Transplantation (IAT). You will need your medical records: discharge summaries, test results, a list of medicines and details of previous operations and blood transfusions.
Some tests can be done locally through your GP or a regional laboratory, while others are only available at the transplant centre. How long it takes depends on the organ, your health and whether problems are found that need treating first.
The main medical tests
| Area | What is usually checked |
|---|---|
| Immunology | Blood group, HLA tissue typing, HLA antibodies (panel reactive antibodies), crossmatch with a specific donor |
| Blood and organ function | Full blood count, clotting, kidney and liver function, blood sugar, cholesterol |
| Infections | Hepatitis B and C, HIV, syphilis, cytomegalovirus, Epstein–Barr virus, tuberculosis and others as needed |
| Heart and blood vessels | ECG, echocardiogram, stress test, coronary angiography for some patients, vascular Doppler |
| Lungs | Chest X-ray or CT, lung function tests |
| Imaging | Ultrasound, CT or MRI of the abdomen, blood vessels or the organ itself |
| Cancer screening | Depending on age and sex: mammography, cervical screening, colonoscopy, prostate and skin checks |
| Other | Dental check, gynaecological or urological review, bone density, nutrition |
The exact list depends on the organ. For a kidney transplant the pelvic blood vessels and bladder are assessed; for a liver transplant the liver's blood vessels and any tumours; for a heart transplant the pressure in the lung circulation; and for a lung transplant exercise capacity, bone density and airway infections.
Tissue matching and antibodies
Donor and recipient blood groups must be compatible, except in special blood-group-incompatible programmes offered by some centres. HLA typing identifies your tissue markers. It also matters whether you carry antibodies against other people's HLA – these can develop after pregnancy, blood transfusion or a previous transplant. The crossmatch checks whether your blood reacts against cells from a specific donor; a positive crossmatch usually means that organ is not suitable.
That is why people on the waiting list give regular blood samples and should tell the centre about any transfusion, pregnancy or infection.
Getting your body ready: vaccines, teeth and weight
- Vaccinations. Live vaccines are usually avoided after a transplant, so any that are needed are given beforehand. Protection against hepatitis B, measles, chickenpox, pneumococcus, flu and others is checked.
- Teeth. Any source of infection in the mouth should be treated before surgery.
- Weight and nutrition. Being very overweight or undernourished increases risk; a dietitian can help you prepare.
- Fitness. Walking and rehabilitation before surgery make recovery easier.
- Tobacco and alcohol. Most programmes require you to stop smoking, and people with liver disease need to stop drinking.
Assessing a living donor
When the organ will come from a living donor – a kidney or part of a liver – the donor has a separate, even stricter evaluation designed to protect their own health. Kidney or liver function, heart, blood pressure, blood sugar, infections and cancer risk are all checked, and imaging shows the organ's anatomy.
The donor is assessed by a doctor who is not involved in the recipient's care and can withdraw at any time without giving a reason. An ethics committee checks the relationship between donor and recipient, that the donation is voluntary and that no payment is involved. Buying and selling organs is a crime everywhere – see our guide to organ donation law and ethics.
What can the outcome be?
- Suitable – you join the waiting list or a living donor transplant is scheduled.
- Not yet suitable – a problem such as an infection, heart disease or excess weight needs treating first, and the assessment is repeated afterwards.
- Not suitable – the risks outweigh the expected benefit. The team will discuss other treatment and support, and you can ask for a second opinion.
Evaluation abroad and when to talk to your doctor
Some patients from Bulgaria and elsewhere in Europe have their assessment or a second opinion at large accredited hospital groups in Istanbul, particularly when considering a living donor transplant from a family member. In Türkiye, living donation is allowed only within the law – the donor is usually a relative or spouse, and other cases require ethics committee approval. Check the accreditation, the team's experience, the written plan and how results will be shared with your doctors at home. An organiser such as New City Clinic can coordinate the hospital, doctor, hotel, transfers and interpreter.
Ask your specialist about a referral for evaluation if your kidney function is at stage 4–5, or you have decompensated cirrhosis, severe heart failure or advanced lung disease. If you are already being assessed, tell the centre about any new illness, hospital admission or change in medicines.
Frequently asked questions
How long does a pre-transplant evaluation take?
Usually from a few weeks to a few months. It depends on the organ, how many tests are needed and whether any problems must be treated first.
Will I need repeat tests while I wait?
Yes. Some tests are repeated regularly, especially blood samples for antibodies, and with a longer wait heart and cancer checks may also be repeated. Your centre sets the schedule.
Can a living donor change their mind?
Yes. A living donor can withdraw consent at any time without giving a reason, and the team keeps that decision confidential.
What happens if I am found unsuitable?
The team explains why and discusses other treatment options. If the reason can be treated, the assessment may be repeated later. You can also ask another centre for a second opinion.
Sources
This article is for education and does not replace consultation, diagnosis or treatment by a doctor. In an emergency call 112.
