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ESRD Network 5
The Renal Transplant Option: Evaluation, Presentation, & Documentation
For all Patients in a maintenance Dialysis Program...
Suitable Patients:
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Psychologically stable
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Understand risks, hazards & benefits of transplant
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Free of uncorrectable medical conditions
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Less than 70 years of age (varies per Transplant program)
The Medical Record Will Indicate That:
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The patient has been medically and psychosocially evaluated by the professional care team (a multidisciplinary team including, but not limited to, a nephrologist, a nurse, a social worker and a dietitian; review by transplant center, i.e. designated individual, may be accomplished by mail)
AND
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The patient has been classified as a suitable or unsuitable candidate for transplantation. Patient transplant classification should be completed within 90 days following initiation of dialysis.
Unsuitable Patient:
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Untreatable psychopathology
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Alcohol or drug abuse
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Morbid obesity
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Advanced cardiac or vascular disease
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Recent (or incurable) malignancy
Consultation with the transplant center is encouraged before determining unsuitability.
The Nephrologist may wish to review: Criteria for Ratings of Appropriateness for Renal Transplantation: Epstein AM, et al: Racial disparities in access to renal transplantation. The New England Journal of Medicine. (Volume 343:1537-1544, November 23, 2000.)
INFORM PATIENT & DOCUMENT DECISIONThe Medical Record Will Indicate That:
- Patients determined not suitable for transplant referral were informed of this determination.
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Suitable patients were presented the option of referral to a transplant center for evaluation, and received information on cadaveric and living donor transplant.
For Patients Electing Evaluation for Transplantation:
A. The medical record will document referral to a transplant center
B. Process to evaluate patient for cadaveric or living donor transplant initiated
C. Patient wait-listed for cadaveric transplant and/or scheduled for living donor transplant
D. Patient deemed unsuitable candidate for transplant
E. Patient refused the transplant option after further consideration
REVIEW ANNUALLY
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The Centers for Medicare & Medicaid Services (CMS) Subpart U Regulations mandate the generation of a written Patient Long-term Program and Care Plan, updated yearly, representing the selection of a suitable treatment modality (i.e. dialysis or transplantation).
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Treatment modality must be reviewed with all patients annually, regardless of prior suitability or referral decision.
Network 5 Transplantation Goals and Recommendations,
2007-2009
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All facilities should monitor the transplant status of patients to ensure that < 5% have no transplant status established.
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100% of dialysis 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, and who conducts annual follow-up education/contact with patient.
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100% of dialysis facilities should designate one staff member to serve as the transplant liaison to oversee transplant education, evaluation referrals, submission of laboratory samples, and patient status changes.
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100% of Network 5 transplant centers will provide written kidney transplant inclusion and exclusion criteria to dialysis facilities referring patients for transplant evaluation or transplant centers will post a link to this information on the MARC web site.
* 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.
