Protocols on this page concern Edinburgh management of deceased donor kidneys.
Local donor procedure
- Tissue type to be established as soon as possible, usually from peripheral blood lymphocytes (see appendix IV).
- UKT will inform the donor transplant co-ordinator of the allocation of the kidneys as per National allocation schemes so that the kidneys can be packed and addressed to the appropriate centre. UKT or the donor recipient co-ordinator will then contact the local renal recipient transplant co-ordinator with a kidney or kidney/pancreas offer if appropriate.
Offers from Deceased Donors after Brain Death (DBD) (heart beating donors)
- The on-call renal recipient transplant co-ordinator will receive the offer of a kidney from UKT.
- Transplant co-ordinator contacts transplant surgeon and asks for a decision as to whether the kidney should be accepted.
- If the decision has been made to go ahead, then the transplant co-ordinator contacts the patients own local Consultant Nephrologist and the RIE on call Consultant nephrologist, to ensure that the patient is fit and should be called.
Donation after cardiac death (non-heart beating donors)
NB: Because of difficulties of getting local match run to H&I/coordinators from West of Scotland donors (i.e. those typed in GG&C H&I, Gartnavel Hospital) this revision to allocation will initially be for East of Scotland donors only. Patients for West of Scotland donors will be selected as currently.
East of Scotland donors:
After receipt of the UKT ‘local’ allocation match run a patient is selected for XM, prioritised as follows:
- 000 matched patient, or
- the longest waiting patient in match Levels 2/3 with a current (<3/12) serum sample available who has had no sensitising events since the last sample. If the longest waiting patient is not suitable/available then the next longest waiting patient will be selected, etc
Two backup patients will also be selected working down from the top of the match run list who are HLA antibody negative with current (<3/12) sample available.
West of Scotland donors:
Patients for crossmatch are selected according to the UKT ‘local’ allocation match run. The patient at the top of the run is selected for crossmatch. The reasons for any deviation from this selection must be clearly explained to the coordinator. As the kidney is to remain locally back up patient(s) may be selected for XM in consultation with the local coordinators.
Allocation of DCD will be jointly audited by H&I and recipient coordinators and will record how often the above policy was adhered to, reasons for deviations from this policy and the individual making the decision to deviate from the policy.
- Transplant co-ordinator performs the following tasks:
- Contact of the patient.
- Arrangement of transport for the patient and his/her notes to the renal transplant unit. NB: APD patients to bring own machine.
- Alert renal transplant unit and give details of patient and dialysis needs.
- Alert the renal registrar with the patient details.
- Alert Hospital at Night to clerk patient or any other specific requests.
- Alert the tissue typist with the patient details.
- It is the responsibility of the transplant co-ordinator to organise theatre. Informing the anaesthetist and on call theatre person to book the first available operating space.
- It is the responsibility of the renal registrar, and the on call consultant nephrologist to ensure the chosen patient is adequately dialysed and medically fit prior to operation.
- The on-call renal reg or HAN also liases with BTS regarding grouping and saving.
Fife, Dundee, Aberdeen and Inverness patient arrangements:
Transplant co-ordinator will discuss the patient with the surgeon and patient’s local nephrologist. If the kidney is to be accepted, the transplant co-ordinator will also inform the RIE consultant nephrologist on-call.
The nephrologist or the transplant co-ordinator to contact the patient. The renal recipient transplant co-ordinator arranges transport of the patient to the RIE.
The transplant co-ordinator or local nephrologist arranges the patient’s notes to be sent to the transplant unit ASAP.
If the patient requires dialysis this is to be organised in Edinburgh. The MRSA and virology status of the patient must be known.
Otherwise as above.
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