Transplant Referral Guidelines

Guide to Timely Assessments and Appropriate Referrals of ESRD Patients for Kidney Transplant.

The following guidelines have been developed in addition to the Network Criteria and Standards to encourage timely and appropriate assessment for referral of patients for consideration for kidney transplantation. The goal of the Network is to promote access to transplantation for every individual who may be eligible for such a procedure.

Assessment for transplantation

• All patients should be thoroughly assessed for transplant referral when the first Long Term Program is completed within the first 30 days of care in the ESRD facility and when a change in status occurs that would impact their suitability for transplantationⁱ.
• Transplant center guidelines for selection of appropriate candidates vary however patients that are unsuitable for referral may include: patient refusal, + HIV status, pediatric patients with small size or malnutrition, cancer, active TB and against justifiable medical judgmentⁱⁱ.
• After referral, follow-up of transplant evaluation and waiting list status should occur as part of the short-term care plan process. Any barriers to the patient’s transplant eligibility should be addressed with the patient by the team.
• Transplant status and staff efforts in this area should be documented on each care plan.

Access to Care

• Individuals considered candidates for transplantation may be referred by their primary care Nephrologist, dialysis unit or by self-referral.
• Patients may be listed at more than one transplant center.

Continuity of Care

• Active and ongoing communication is required between the Transplant Team, the Nephrologist and dialysis facility staff to maintain continuity of care throughout the transplant process, from initial referral to long term care of the transplanted kidney.
• If the patient has signed appropriate authorization for release of records dialysis facilities should respond promptly to all requests by the transplant organization for medical records or other referral information.
• Transplant evaluation may result in the discovery of a condition that requires correction prior to elective transplant procedure. The transplant center should consult with the patient and the primary care physician to manage these conditions.
• Dialysis facilities should assist kidney transplant candidates with factors that might affect their eligibility for transplant. These factors might include addressing severe obesity, reinforcing adherence to prescribed medication or therapy, and addressing social/emotional/financial factors related to ability to function post transplant as part of care planning.
• Dialysis facilities and Transplant centers should encourage patients to consider living donor kidney transplant and seek to identify a suitable living donor when possible.

i ESRD Network #14 - Medical Review Board 2006 Physician Standards for Care of ESRD Patients in the Outpatient Setting

ii ESRD Network #14 - Medical Review Board 2006 Physician Standards for Care for the Appropriateness of Modality of ESRD Patients in the Outpatient Setting

Page Updated/Reviewed on 09/10/06