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Transplant Referral Guide

ESRD Network 5
The Renal Transplant Option: Evaluation, Presentation, & Documentation
For all Patients in a maintenance Dialysis Program...

EVALUATE & CLASSIFY PATIENT

Suitable Patients:                 

  • Psychologically stable
  • Understand risks, hazards & benefits of transplant
  • Free of uncorrectable medical conditions
  • Less than 70 years of age (varies per Transplant program)

The Medical Record Will Indicate That:

  • 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
  • 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:

  • Untreatable psychopathology
  • Alcohol or drug abuse
  • Morbid obesity
  • Advanced cardiac or vascular disease
  • 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 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, and received information on cadaveric and living donor transplant.
DOCUMENT TRANSPLANT STATUS

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

  • 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).
  • Treatment modality must be reviewed with all patients annually, regardless of prior suitability or referral decision.

Network 5 Transplantation Goals and Recommendations,
2007-2009

  • All facilities should monitor the transplant status of patients to ensure that < 5% have no transplant status established.
  • 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.
  • 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.
  • 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.

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