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. Patients may be referred to the Transplant Center for consideration by their nephrologist.

If you have access to TxAccess, please submit your referral electronically. If you do not have access to TxAccess and would like to begin referring patients electronically, please complete the form. If you prefer to submit a referral via fax, please print and complete the referral form and privacy release. An incomplete referral will delay your patient's case.

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

The referral may be mailed 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.

Evaluation Process

The intake team reviews all referrals and contacts your patient. The patient's information also is forwarded to a transplant financial coordinator to verify transplant coverage.

Once authorization for the evaluation is obtained from the insurance company, the patient is scheduled for an outpatient evaluation, which includes:

• Education sessions
• Psychiatric/social evaluation
• Transplant nephrology evaluation
• Transplant surgeon evaluation
• Transplant financial coordinator evaluation and counseling
• Chest X-ray
• Electrocardiogram
• Laboratory work, including serologies and tissue typing (HLA)
• Other testing as indicated by a patient's condition

The following tests are the responsibility of the patient:

• Mammogram within 12 months for females over 40
• Pap smear within 12 months for females over 18
• Colonoscopy for patients over 50

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

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