Transplant assessment

  • The referring nephrologist undertakes the work up for kidney transplantation.
  • The optimal time for referral for kidney transplantation is prior to commencement of dialysis, and the agreed guideline for referral is when the estimated GFR is <20ml/minute.
  • Patients are referred to the transplant assessment clinic, where they may be seen by any one of the consultant transplant surgeons, +/- consultant nephrologist and a renal recipient coordinator.
  • The referral letter must be accompanied by the transplant recipient checklist and summary (see Referral for Transplant; or complete relevant EPR Vitaldata sections. In principle it has been agreed that this checklist provides comprehensive information that should be sufficient to make a decision about listing in the majority of cases.
  • If the consultant surgeon requests further investigations, these are outlined in the Outcome of assessment page, which remains in the patient’s notes.
  • The person responsible for ordering further investigations must be explicit within in the clinic letter. This will vary depending on whether the patient is local or from one of the referring centres.
  • The transplant coordinator will arrange for copies of all the required investigations prior to listing, and the checklist for these will be completed.
  • When investigations are complete, the transplant team will review the results in a timely fashion.
  • The decision about listing the candidate for kidney transplantation will be made by the transplant surgeons and nephrologists after discussion with the multi-disciplinary team and the patient.
  • When the decision is made and the patient listed for renal transplant, they should be labeled as one of the following:

GREENstraight forward, no significant concerns. Patients to be reviewed initially in 2 years and then annually.

AMBERconcerns re. suitability for transplant, should be reviewed at least annually.

RED significant concerns re. suitability for transplant. Consideration should be given 6 monthly as to whether or not the patient should remain on the waiting list.

  • The patient will be directly informed, verbally and in writing, of the decision regarding listing by the transplant coordinator.
  • Patients will have the opportunity for detailed discussion regarding kidney transplantation and will be counselled with respect to relative risks and benefits of cadaveric and living donor kidney transplantation.
  • An information booklet is also given to the patient to support the verbal information given at the assessment clinic.
  • National NHSBT/BTS guidelines advise that informed consent should be obtained from the patient at the time of acceptance for inclusion on the waiting list. More details with regards consent are in Appendix II.