Kidney Transplant Program

To refer a patient for kidney transplant evaluation, please call 1-855-366-7989, Mon–Fri 8 a.m. – 4:30 p.m.

The following items are required for a kidney transplant referral to be processed:

• Completed pre-kidney transplant evaluation referral form
• Front and back copy of the patient's insurance card(s)

These items can be faxed to 404-727-8972.

To transfer a patient with a functioning kidney transplant to establish follow up care, please complete the post-kidney transplant transfer form.

• Send the form along with requested documents (listed on page 2 of the form) to 404-727-8972.
  

Referral Guidelines

• Virtually any patient with a condition that leads to stage 4 (glomerular filtration rate [GFR] <30 mL/ min) or greater chronic renal failure may be referred for transplant education and evaluation.
• Patients do not have to be on dialysis to qualify for kidney transplantation. We prefer to evaluate and educate patients early in the course of their disease, thus providing the opportunity for preemptive transplantation.

We offer kidney transplantation protocols for patients with sickle cell disease, HIV infection and morbid obesity.

Eligibility Criteria

• Stage 4 (GFR<30ml/min) or greater chronic kidney disease
• Absence of a systemic illness or medical condition that significantly decreases estimated short- or long-term survival. Examples include severe cardiovascular or peripheral vascular disease and disseminated malignancy.
• Ability to be compliant with a complicated long- term medical treatment regimen. Important factors may include a strong social/family support system and freedom from active drug or alcohol abuse.
• An adequate financial plan to obtain the required long-term immunosuppressive medications needed post-transplant. 

Referral Process

After we receive a referral, we will fax a confirmation to the referring provider. The patient will be contacted via mail with information/instructions and his/her individual code for our on-line education program, EMMI: Organ Transplant Overview.

Patients must complete the on-line education within thirty days of receipt of the letter to move forward to evaluation. Patients who do not have computer access/ability or who do not read/speak English are asked to contact us to arrange another plan for transplant education.

Patients who do not contact the center for assistance/do not complete the on line program within the allotted 30 days will be released from the process. The referral will be closed and a letter will be sent to the patient, referring provider and dialysis center (if appropriate) indicating that we have closed their record.

Patients who contact the center for assistance/complete the on-line education program will be contacted and scheduled for evaluation.

Kidney Transplant Evaluation Process

Virtually any patient with a condition that leads to renal failure may be referred for transplant education and evaluation. A patient does not have to be on dialysis to qualify for kidney transplant. We prefer to educate and evaluate patients early in the course of their disease.

We may evaluate patients even if they are not candidates for transplant at this time. For example, if the patient has a successfully treated malignancy and requires a waiting period prior to transplant and immunosuppression, it would be advantageous to proceed with evaluation and potentially listing for transplant. The patients would be listed in an inactive status, so that they would not be offered organs for transplant but would accrue credit for waiting time.

We evaluate patients for kidney transplantation who previously may not have been considered. Examples include patients with sickle cell disease, HIV infection, or morbid obesity. Morbid obesity protocol requires weight loss to a BMI of 35 or less prior to renal transplantation, and a BMI of 30 or less prior to combined kidney and pancreas transplant.

If there is uncertainty regarding a patient’s candidacy for transplant, please refer the patient for evaluation and contact us at 855-366-7989.

Renal Transplant Evaluation:
Day one of the kidney transplant evaluation will consist of several tests and appointments. Patients will be scheduled for an EKG, a chest x-ray, and consultations with a mid-level provider, a social worker, a financial coordinator, a pre-transplant coordinator and a dietician. Interim testing will be scheduled for each candidate based upon day one findings and evaluation protocol. Outside records will be obtained, reviewed and prepared for the consultants who will see the candidate on day two.

Day two of the evaluation will take place three – four weeks after the day one appointment.
On day two the patient will have consultations with the following specialists:

• Transplant surgeon
• Transplant nephrologist
• Cardiologist (if patient has a history of coronary artery disease requiring intervention such as a CABG or angioplasty/stent placement or history of severe cardiomyopathy)
• Mental health specialist (if patient has a history of depression, bipolar disorder, schizophrenia, eating disorder, noncompliance, significant substance abuse, or any other mental illness)
• Hepatologist (if the patient has a history of hepatitis B or C or other liver disease)
• Hematologist (if the patient has a history of sickle cell anemia or other hematologic disease)
• Pulmonologist (if patient has a history of COPD or sleep apnea)

Additional testing that may be performed include:

• Colonoscopy (required in all patients over age 50 who have not had a colonoscopy in the last 10 years)
• Pap smear and gynecological exam (following ACOG guidelines) are required as directed for HIV negative recipient candidates. Age 21 – 30: every two years, age30 and older: every three years as long as the most recent exam was negative.
• Mammogram (required in all women over the age of 35 and should be performed within one year of the transplant evaluation then maintained annually)
• MRI or CT of abdomen and pelvis (required in all patients with diabetes and all patients with a history of peripheral vascular disease.
• Carotid duplex (required in all diabetic patients and in other patients as indicated by medical history or physical examination findings)
• Cardiac testing (may consist of an echocardiogram, a dobutamine stress test or a thallium stress test)

A letter will be sent to the referring physician after day two of the evaluation, updating the patient’s status. 

Kidney Transplant Listing Process

One- two weeks after the day two evaluation, the patient’s case will be presented at a multidisciplinary transplant selection committee meeting. There are three possible outcomes:

1. Approved for Transplant
The process will be initiated to place the patient on the waiting list for a transplant. The patient may be placed on the list in an "active" status, which means there are no outstanding issues and the patient is eligible to receive organs that are offered. If there are issues that need to be resolved prior to proceeding to transplant, the patient will be in an "inactive" status. In this case the patient will not receive organ offers but will accrue credit for waiting time on the transplant list. Potential living donors for patients in this status should proceed with their evaluation for donation.

2. Evaluation Incomplete
These patients have medical, psychosocial or financial issues that need further evaluation prior to determining their transplant candidacy. These patients will have 90 days to complete the required testing, consultations, etc. that are required to make a final decision. The patient's pre-transplant coordinator will facilitate this process.

3. Not a Transplant Candidate
These patients are, in our opinion, best served by an alternative treatment for their kidney disease. They will return to their referring nephrologist to discuss these options.

Patients will be notified of the committee decision within three business days of the committee meeting. Patients and referring nephrologists will receive a letter and copy of the Transplant Evaluation Summary. This summary indicates the patient's current transplant status and lists all items that must be resolved in the next 90 days in order for the patient to be approved for transplantation and placed on the waiting list. The referring nephrologists will also receive copies of the lab results, diagnostic study reports and consultation reports.

Pre-transplant coordinators work with patients to complete any outstanding requirements listed on the Transplant Evaluation Summary within 90 days of the transplant evaluation. If the listed items are not completed within 90 days, the patient's evaluation status will be closed. To re-enter our program at a future date, the patient must be re-referred by the referring nephrologist. Should the referring physician wish for the committee to reconsider their decision, he or she may contact the transplant office at 855-366-7989.