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Post Donation Monitoring of Live Kidney Donors (4.18)

Post Donation Monitoring of Live Kidney Donors (4.18) - Policies, Administrative, UWHC, Department Specific, Transplant, Living Donor

4.18



POLICY & PROCEDURE
Effective Date: October 2007
Revised Date: August 2013
Title: Post Donation Monitoring of Live Kidney
Donors
Policy Number: 4.18

Page 1 of 2
I. PURPOSE

The purpose of this policy is to provide standards of care for multidisciplinary team to ensure that
post-nephrectomy living kidney donors are managed with a consistent, high level standard of
care. Donor nephrectomy reduces glomerular filtration rate (GFR) by approximately 50%
initially. GFR gradually improves due to hypertrophy of the recovering kidney. Donors should be
monitored for recovery of wound healing, renal function, development of risk factors for Chronic
Kidney Disease (CKD), and psychosocial impact of live donation.

II. POLICY

It is the policy of the UW Transplant program to adhere to the University of Wisconsin Hospital &
Clinics (UWHC) standards of patient care, as well as the standards determined by regulatory and
accrediting agencies, such as The Joint Commission (TJC), the Organ Procurement and
Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS), and the Centers for
Medicare & Medicaid Services (CMS).

III. FORMS
Guideline 4.18A (pdf)

IV. PROCEDURE

A. Each donor patient will receive the following standard of care after being discharged from UW
Hospital for their nephrectomy:
1. Post-Discharge:
i. For urgent issues: Initial patient contact is the pre-transplant coordinator during
office hours and the transplant coordinator on-call after hours. If indicated, the
transplant or surgical team involved in the donor nephrectomy will be contacted.
B. Post-Operative Follow-up:
1. Transplant or Urology Clinic approximately 2-3 weeks post donation and the Transplant
clinic 5 months, 1 and 2 years post-donation where the patient will be seen by members
of the multidisciplinary team which may include: physician/surgeon and/or a PA/NP,
social worker, living donor advocate, transplant coordinator and/or clinic nurse. If the
patient chooses, they may be seen locally by their primary care provider for the 5 month,
1 and 2 year visits.
2. Coordinator to forward complications (if any) to data coordinators for
documentation. Coordinators must notify data coordinators immediately upon
notification of a living donor death (regardless of cause) or native organ failure so that



POLICY & PROCEDURE
Effective Date: October 2007
Revised Date: August 2013
Title: Post Donation Monitoring of Live Kidney
Donors
Policy Number: 4.18

Page 2 of 2
this information can be reported to UNOS within the 72 hour timeframe. (See policy
3.20)
C. If the patient is unable to return to UWHC for follow up, they may:
1. See primary care provider or local surgeon at 2 weeks with protocol labs as outlined in
Guideline 4.18A
2. Have post donation labs drawn locally (5 months/1 year/2 years).
3. Coordinator to have all labs, correspondence and complications (if any) entered/scanned
into the patient's electronic medical record.
D. Patient may revisit UW provider between appointments with any donation-related
complications.
E. If estimated GFR <60mL/min with="with" hypertension="hypertension" or="or"
significant="significant" proteinuria,="proteinuria," consider="consider" referral="referral"
to="to" a="a" nephrologist.
F. Recommended annual follow up with primary care provider:
1. History and exam
2. Blood pressure measurement
3. Labs
i. Serum creatinine
ii. Urine microalbumin

V. COORDINATION

University of Wisconsin Transplant Program

VI. REVIEWED BY

Transplant Service Line Policy and Procedure Committee 8/2013

VII. SIGNED BY


________________________________ _________________________________
Jill Ellefson, MBA Dixon Kaufman, M.D., PhD
Organ Donation and Transplant Service Line Chair, UW Transplant Program