When to Refer a Patient for Kidney Transplant
Patients with or nearing end stage renal disease may be considered for renal transplantation. Carolinas Medical Center does not have absolute age criteria; instead, all patients are reviewed on an individual basis to provide non-discriminatory consideration.
Unsure if your patient should be referred for transplant? Any patient may be referred to the Transplant Center for consideration by the transplant team. Let us make the decision for you!
Contraindications to renal transplant:
- Active substance abuse
- Advanced cardiovascular disease as determined by the multidisciplinary team
- Patient refusal
- Progressive dementia and/or severe, irremediable psychotic impairment which interferes with medical compliance
- Untreated and/or active malignancy
- No age criteria; patients reviewed individually
Considerations for Simultaneous Kidney-Pancreas Transplantation:
Patients with Type 1 diabetes mellitus will be considered for kidney-pancreas transplantation with the following guidelines:
- Age < or equal to 60
- BMI < or equal to 35
Patients with Type 2 diabetes mellitus will be considered for kidney-pancreas transplantation with the following guidelines:
- Age < or equal to 57
- BMI < 27
- < 1.0 units insulin/kg/24 hours
- Must be a candidate for steroid avoidance protocol
- Must have evidence of secondary microvascular complications
Contraindications for combined kidney-pancreas transplantation:
- Untreated or active malignancy
- Chronic or active infection
- Untreated or active cardiac ischemia
- Advanced heart failure
- Advanced liver disease
- Advanced cerebrovascular or neuro-degenerative disease
- Severe chronic lung disease
- Active collagen vascular disease
- Uncorrected urologic disease
- Excessive obesity
- Severe malnutrition
- Ongoing non-adherence to medications or treatment regime
- Active substance abuse, including smoking and smokeless tobacco
- Marked deconditioning
- Social instability, in particular poor family support and limited resources to maintain ongoing follow-up
- Patient’s lack of interest or refusal
- Patient's refusal to accept a blood transfusion in life-threatening situations
How to refer a patient for transplant
If you do not have access to TxAccess and would like to begin referring patients electronically, please complete the form
Mail or Fax this referral form to:
CMC Transplant Center
P.O. Box 32861, Charlotte, NC 28232
Or faxed to 704-446-4876.
For additional information on the referral process, contact the Kidney Intake team at 704-355-6649 or 800-562-5752.
The following documents must be included with the referral:
- Legible copy of BACK and FRONT of all insurance and prescriptions cards
- Medicare Form 2728 (if on dialysis)
- Patient's signature in 2 places:
- Page 1 HIPAA Privacy Act
- Page 3 Authorization for Release of Health Information
- History and Physical (within 1 year)
- Current List of Medications
- Current Labs results
- PPD results (within 1 year)
- Nutritional Assessment
- Psychosocial Assessment
Roadmap to Transplant
The referral process for a kidney transplant usually begins when a diagnosis of kidney failure is given by a nephrologist who then assesses the patient's overall health and kidney function. This assessment is used to determine whether a kidney transplant can be considered as a treatment option. If transplantation is deemed appropriate, the nephrologist initiates the patient’s referral process to the Atrium Health Carolinas Transplant Center.
The evaluation process includes a series of medical tests and consultations designed to assess a patient's overall health and suitability for the surgical procedure. The evaluation is conducted by a multidisciplinary-team of specialists, including nephrologists, kidney transplant surgeons, nurses and social workers, who factor together the patient’s medical history, their current health, and any potential risks or complications associated with the transplant. Additionally, laboratory tests, imaging studies, and diagnostic procedures may be conducted to gather additional information as necessary. Following the evaluation, the transplant team discusses the findings and collaborates to develop an individualized treatment plan tailored to the patient's specific needs.
Patients will be responsible for completing the following health maintenance screening as part of their evaluation:
- Mammogram within 12 months for females over 40
- Pap smear within 12 months for females over 18
- Colonoscopy for patients over 50
The process of waiting for a donor kidney can vary in length and have a significant impact on the outcome of a transplant. Patients with end-stage kidney disease typically join a waiting list maintained by the United Network for Organ Sharing (UNOS) in the United States. Because of the potentially long wait for a match on the waiting list, patients may explore various sources for a donor kidney, including deceased donors, living donors such as family members or friends, and paired exchange programs. Deceased donors are individuals who have registered to donate their organs upon death, providing an opportunity for transplantation to those in need. Living donors are willing individuals who may or may not be related to or know the transplant candidate, decide to undergo evaluation to determine their suitability for donation. Additionally, paired exchange programs allow incompatible donor-recipient pairs to exchange kidneys with other pairs, increasing the chances of finding a suitable match. Learn more about our living donation program here (add link to living donor subpage).
A kidney transplant is the culmination of many people’s hard work and determination, and the crossroads of the patient's and physician's journey. For the patient, there is renewed hope and the prospect of a healthier and overall better quality of life, free from the constraints of dialysis. It's a culmination of a challenging wait overcome by with the strength of their resilience and determination. For the physician, it signifies the successful culmination of a complex medical procedure, one that requires incredibly meticulous planning by an entire team, skillful execution of the work they have dedicated years of their lives and their careers to, and ongoing care. Witnessing the patient's improved quality of life post-transplant is immensely rewarding and reinforces their dedication to providing the best possible care.
Outcomes:
After a kidney transplant, patients typically undergo a period of close monitoring and recovery. They receive medications to prevent rejection of the new kidney and to manage other post-transplant complications. Regular follow-up appointments are scheduled to assess kidney function, monitor medication levels, and address any concerns. Patients are advised to adhere to a healthy lifestyle, including a balanced diet and regular exercise, to optimize the function of the transplanted kidney. Over time, with proper care and management, many patients experience improved quality of life and long-term success with their transplanted kidney.
Dialysis Unit Resources
If you have questions about patients in any phase of transplant, please call 704-355-6649.
Alternatively, you can email us for non-urgent requests at
- Intake team (for questions about referrals)
- Waitlist team (for questions about patient already on our waiting list)
- Living Donor Team (for all questions about living donation)
Forms
Would you like to request a lobby day to offer your patients and staff more information about transplant? Please call 704-355-6649 or email kidneyintake@atriumehalth.org.