Emory Transplant Center



Organ Placement Program Management: Renal Pancreas: Evaluation of Renal Pancreas Donors: Procedure

|Statement: | |1. Activation date: 10/10/2007, Amendment 05/07/2008, Amendment 9/5/08, Title Amendment 10/7/08, Amended |

| | |1/5/09, Amended 4/6/09, Amended 5/18/09, Amended 1/27/10, Amended 4/24/13, amended 12/21/14, amended 1/6/15, |

| | |amended 2/26/15, amended 12/13/16, amended 1/31/17 |

| | |2. Affected Department: Renal Pancreas Transplant Program, Emory Organ Placement Program |

| | |3. Policy Statement: It is the policy of the Renal Pancreas Transplant Program to appropriately select and |

| | |manage potential Renal Pancreas transplant donors and potential Renal Pancreas transplant recipients |

| | |4. Basis: This policy is necessary for the protection of patients, physicians and staff. |

| | |5. Administrative Responsibility: Section heads, physicians, practitioners, and staff are responsible for |

| | |compliance with this policy. |

Procedure: Acceptance Criteria for Both Local and Import Offers (unless specified)

ALL 0 MISMATCH, and AB BLOOD TYPE DONORS ARE TO BE REVIEWED WITH SURGEON ON CALL.

PHS Increased Risk/Presumed Infected:

|Donor Serologies |Donor NAT Testing |Appropriate Kidney & K/P Recipients |

|HIV, HCV & HBcAb Negative |NAT Negative |All Kidney and K/P Recipients. |

|HBcAb Positive |HBV NAT Negative |Kidney and K/P Recipients who are Hep B Positive and/or have HBsAb |

| | |testing, have consented and labs are UTD. Code 834 if criteria not met. |

|HBcAb Positive |HBV NAT Positive |Kidney and K/P Recipients who are Hep B positive and/or have HBsAb |

| | |testing, have consented and labs are UTD. Code 834 if criteria not met |

|HCV Positive |HCV NAT Negative |Kidney and K/P Recipients who are Hep C Positive and current Hep C by |

| | |PCR, have consented and labs are UTD. Code 834 if criteria not met. |

|HCV Positive |HCV NAT Positive |Kidney and K/P Recipients who are Hep C Positive and current Hep C by |

| | |PCR, have consented and labs are UTD. Code 834 if criteria not met. |

|HIV Positive |HIV NAT Positive |Consider for KIDNEY ONLY, for HIV Positive recipients, have consented |

| | |and labs are UTD.  |

| | |Code 834 if criteria not met. |

|HIV+ and/or HBcAb and/or HCV Positive |HIV NAT Positive |WILL NOT CONSIDER.  Code 834. |

Organ Placement Program Management: Renal Pancreas: Evaluation of Renal Pancreas Donors: Procedure p.2

Maximum Age: 70 years

Minimum Donor Weight: Pediatric En Bloc: for recipients < 90kg

20 Will consider for single kidney

2 for 1: Will not consider

Donor Trauma: Will not consider donor with bowel perforation resulting in gross contamination

Donor malignancy: Will consider localized cancer > 10 years ago

Will consider non-melanoma skin cancers

Diabetes: Will consider donor: May need acceptable biopsy and waiver

Hypertension: Will consider donor. May need acceptable biopsy and waiver

Terminal Creatinine: Will not consider donor if peak is =/> 4, stable or rising

Will consider donor if peak is > 4 and falling

Biopsy Results: Will not accept donor biopsy with greater than 15% glomerular sclerosis.

Pancreas & K/P: Will NOT consider if donor is greater than 500 miles from Emory Transplant Center, UNLESS offer is a 0 mismatch for intended recipient who is highly sensitized with a PRA of >80%.

Age:

Import - Will consider if donor is 44 years of age or younger

Local - Will consider any age donor.

Increased Risk:

Local AND Import– will consider any Increased Risk donor using criteria above.

DCD donor: Kidney: will consider if donor KDPI is less than 85%.

May refuse 830 if donor is DCD and KDPI is 85% and higher.

Kidney/Pancreas: Will NOT consider

Whole Pancreas: Will NOT consider

Pancreas for Islets: Will NOT consider

Cold Ischemic Time: Will NOT consider for import offers if estimated time of arrival to ETC is >/=

30 hours- May code 835 for organ preservation.

Sequence # on match run: The Organ Placement Coordinator will not call the surgeon on call if the first potential recipient for an import donor is at sequence # 500 or greater on the list. May code 830 for donor quality.

KDPI: LOCAL offers: Organ Placement Coordinator will call the surgeon on call regardless of KDPI %.

IMPORT offers: Organ Placement Coordinator may refuse donor 830 IF the KDPI is >/= 90%.

Organ Placement Program Management: Renal Pancreas: Evaluation of Renal Pancreas Donors: Procedure p.3

Back up status: The Organ Placement Coordinator will call the surgeon on call for all local ECD donors, regardless of ETC position on the match run.

The Organ Placement Coordinator will not call the surgeon on call for all Standard Criteria Donors, and import ECDs if the first potential Emory recipient is 6th on the list or lower and none of the exclusion criteria are met. The coordinator may select “provisional yes”, then will call the surgeon if the recipient’s position on the list advances.

MultiOrgan recipients: If a recipient who requires multi organs is offered a kidney only - Kidney/pancreas donors will be reviewed utilizing the policy.

Liver/kidney donors may be refused 802 (multiorgan transplant required)

Heart/kidney donors may be refused 802 (multiorgan transplant required)

Lung/kidney donors may be refused 802 (multiorgan transplant required)

HLA status: If HLA Director reviews recipient with donor and does NOT RECOMMEND transplant, may refuse 813 (Unacceptable antigens)

Recipient Status: If a potential recipient has previously been bypassed by a surgeon for an organ offer due to pending testing or updated testing/eval needed, the recipient may be declined 801 (recipient temporarily unsuitable) until required testing and review has been completed.

Approved by Renal Transplant Leadership Group

_______________________

Thomas C. Pearson, MD, D. Phil

Chair, Renal Transplant Leadership Group

Director, Renal Transplant Program

____________________________

Casey King, RN BSN

Lead Organ Placement Coordinator

Organ Placement Program

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