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Transplant Facility-Specific Referral Criteria
Network 5 Transplantation Recommendations 2009 - 2010
Transplant Referral Guidance
Transplant Facility-Specific Referral Criteria
§494.80(a)(10) of the revised Conditions for Coverage for ESRD Facilities, effective October 14, 2008, sets forth requirements for patient assessment with regard to transplantation referral:
"Evaluation of suitability for a transplantation referral, based on criteria developed by the prospective transplantation center and its surgeon(s). If the patient is not suitable for transplantation referral, the basis for nonreferral must be documented in the patient’s medical record."
Source: "Medicare and Medicaid Programs; Conditions for Coverage for End-Stage Renal Disease Facilities; Final Rule." Federal Register 73:73 (15 April 2008) p. 20479.
Interpretive Guidance states that regulations for transplant programs require written selection criteria to be developed, and provided upon request, to patients and dialysis facilities. Selection criteria vary among transplant centers; if the dialysis facility refers patients to multiple transplant centers, the dialysis facility should have the selection criteria for each center on file and available to patients.
The following Network 5 Transplant Centers have provided current transplant criteria for ready access to referring dialysis facilities. Click on the facility name to download specific selection criteria.
Charleston Area Medical Center - Charleston, WV (Revised 2/09)
Children's Hospital of The King's Daughters - Norfolk, VA
Children's National Medical Center - Washington, DC
Georgetown University Hospital - Washington, DC
Henrico Doctors Hospital - Richmond, VA
Howard University Hospital - Washington, DC
Hume Lee Transplant Center, VCU Health System - Richmond, VA
Inova Fairfax Hospital (Kidney only) - Fairfax, VA
Inova Fairfax Hospital (Kidney & Pancreas) - Fairfax, VA
Johns Hopkins Transplant Center - Baltimore, MD
Sentara Health System - Norfolk, VA
University of Maryland Medical Center - Baltimore, MD
University of Virginia Medical Center - Charlottesville, VA
Walter Reed Army Medical Center - Washington, DC
Washington Hospital Center - Washington, DC
Network 5 Transplantation
Recommendations
2009 - 2010
- All facilities should establish the transplant status of patients.
- All facilities should have a written policy defining delivery of transplant information to all patients, including:
- when transplant information will be presented to new patients,
- what tools (brochures, video) are used,
- who conducts annual follow-up education/contact with patient.
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All facilities should designate one staff member to facilitate transplant education, evaluation referrals, submission of laboratory samples, and patient status changes.
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All Network 5 transplant centers will provide written kidney transplant inclusion and exclusion criteria to the Network. Links to the criteria are provided above.
*For pediatric patients (<18 years of age) the term "patient" applies to the patient (if they are old enough to understand) AND their identified responsible caretakers.
The Renal Transplant Option Tool
For all patients in a maintenance dialysis program...
Evaluate & Classify Patient
The Medical Record Will Indicate That:
- The patient has been evaluated of suitability for a transplant referral, based on individual transplant center criteria, by the interdisciplinary care team including, but not limited to, a nephrologist, a nurse, a social worker, a dietitian and the patient or patient designee
- The patient has been classified as a suitable or unsuitable candidate for transplantation.
- This initial assessment must be completed within 30 calendar days of admission to the facility or within the first 13 outpatient treatments within the facility.
- The ESRD Conditions for Coverage mandate a comprehensive reassessment of each patient annually (at minimum) with the revision of the Plan of Care. Both the patient assessment and Plan of Care should include reevaluation of treatment modality and transplant status.
Note:
Transplant center criteria designating patients as suitable or unsuitable are listed on the website and can be found at www.esrdnet5.org/treferral.asp#txguidance_specific.
Inform Patient & Document Decision
The Medical Record Will Indicate That:
- Patients determined not suitable for transplant referral were informed of this determination.
- Suitable patients were presented the option of referral to a transplant center for evaluation, received transplant criteria specific to the transplant center, and received information on deceased donor and living donor transplant.
Document Transplant Status
If the patient IS a transplant referral candidate, the medical record will indicate:
- Patient's receipt of transplant criteria (specific for each transplant center)
- Patient's decision to accept of decline the transplant referral
- Plans for pursuing transplantation, if the patient accepts the referral
- Patient refused the transplant option after further consideration
If the patient is NOT a referral candidate, the medical record will indicate:
- Reasons for the non-referral as a transplant candidate
Track Transplant Referrals
- Track the result of each transplant referral
- Monitor the status of each patient on the transplant wait list
- Communicate with the transplant center regarding patient status at least yearly and whenever there is a change in status.
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