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Multidisciplinary Patient Care Team: Living Donor (4.39)

Multidisciplinary Patient Care Team: Living Donor (4.39) - Policies, Administrative, UWHC, Department Specific, Transplant, Living Donor

4.39

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POLICY & PROCEDURE

Effective Date: December 2011
Revised Date: October 2016

Title: Multidisciplinary Patient Care Team‐ Living
Donor


Policy Number: 4.39

I. PURPOSE

The purpose of this policy is to describe the members of the multidisciplinary patient care team that
supports the care of living kidney donors throughout their donation experience including evaluation
phase, donation phase, discharge phase, and post‐donation phase. Also, to describe their role in the
living donor care process.

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, the Organ Procurement and Transplantation
Network (“OPTN”) and the United Network of Organ Sharing (“UNOS”), and the Centers of Medicare
and Medicaid Services (“CMS”).

III. PROCEDURE

Documentation in the living donor chart should include each member's involvement as well as the
patients' progress through each phase of the donation process. The following is a description for
each member of the multidisciplinary living donor team:

A. Transplant Surgeon – Transplant surgeons have been trained to perform living kidney donation
surgery. The surgeon is responsible for participating in the evaluation of potential living donors, the
patient selection meeting, and in the management of patient care during the inpatient donation
phase, discharge process, as well as participating in the long‐term medical management of patients
after donation in collaboration with the medical physicians.
B. Transplant Physician/Nephrologist ‐ The physicians are responsible for participating in the
evaluation of potential living donors, managing medical conditions as appropriate during the
patient’s evaluation phase, inpatient donation phase, discharge process, as well as in the long‐term
medical management of patients after donation as indicated.
C. Transplant Coordinator – Transplant coordinators are registered nurses trained in the field of living
organ donation and receive ongoing education in the field. The transplant coordinator serves as the
primary liaison between the patient and the multidisciplinary team throughout each phase of the
donation process. The coordinator triages and manages the patient’s care and assists with patient
education at all phases of transplantation.
D. Social Workers – Living donor social workers are trained in the field of transplant/living donation
and receive ongoing education in this area. The social worker meets with the living donor during the

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evaluation phase to conduct a psychosocial assessment. The social worker documents psychosocial
concerns pertaining to donation and communicates them to the other members of the
multidisciplinary team. Concerns must be addressed prior to proceeding with donation. The
psychosocial evaluation will be effective until the time of donation unless the social worker
determines that a follow up psychosocial evaluation needs to be performed sooner, depending
upon the individual patient assessment. The transplant coordinator or any other member of the
multidisciplinary team may also request an updated psychosocial assessment of a patient if deemed
necessary. A social worker also participates in the inpatient donation phase as well as the discharge
process. A social worker is available for post‐ donation consultation as needed.
E. Dietitian – Transplant dietitians are trained in the field of transplantation and living donation and
receive ongoing specific education in these areas. The dietitian participates in the evaluation
phase, inpatient donation phase and discharge process for the living donor. The Dietitian assists the
team with monitoring the donor's nutritional status and makes recommendations accordingly.
Education is provided to patients on an individual basis according to patient needs. A dietitian is
available for post‐donation consultation as needed.
F. Pharmacists – Transplant pharmacists are trained in the field of transplantation and living donation
and receive ongoing education in these areas. They work with physicians, staff and patients in
management and education of medications. The transplant pharmacist participates in the medication
administration and management process during all phases of the donation process. The Pharmacist
provides education to the donor, verifies medication lists, and provides education about drug
interactions, dosing guidelines, etc., as required.
G. Anesthesia ‐ A representative from anesthesia participates in the screening of living donors who
proceed with the donation phase. The donors are seen in the pre‐anesthesia screening clinic prior to
donation. Participation continues through the donation phase and immediate post‐operative period.
H. Inpatient Nurses and Clinic Nurses – Inpatient and clinic nursing staff are trained in the field of
transplantation and living donation and receive ongoing education in these areas. They provide
care and education to patient during the donation phase, discharge phase and post‐operative
outpatient follow‐up.
I. Health Psychologist – A health psychologist meets with patients as indicated to access coping
strategies and to perform an assessment; provides ongoing counseling if necessary. They are available
to participate in the discharge planning and instruction if necessary.
J. Coordinated Care Case Management Team‐ The coordinated case management team consists of
nurses, case workers, and social worker who coordinate and assist with discharge planning during the
donation and discharge phase.
K. Independent Living Donor Advocate – The independent living donor advocate is trained in the field of
living donation and receives ongoing education in this area. The donor advocate meets with every
potential living donor to ensure that they have been provided all of the information necessary to make
POLICY & PROCEDURE

Effective Date: December 2011
Revised Date: October 2016

Title: Multidisciplinary Patient Care Team‐ Living
Donor

Policy Number: 4.39

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an informed decision and that there is no coercion. The living donor advocate serves as the
primary liaison between the patient and the clinical care team during each phase of the donation
process: evaluation, donation, discharge, and outpatient follow‐up. This individual shall be focused
on ensuring that the rights of living donor and prospective living donors are protected and that the
donor’s decision is informed and is free of coercion. Donor concerns not resolved by conferring with
the Living Donor Advocate will be escalated as needed to the Hospital Ethics Committee. See Policy
4.48 Living Donor Advocate Process for additional details.
L. Histocompatibility Lab – The histocompatibility lab provides testing services for the living donor
team including crossmatches, HLA typing, donor specific antibody identification. Additionally, a
member of the histocompatibility lab also attends the bi‐weekly Luminex meeting to discuss HLA
results and serves as a resource for the multidisciplinary transplant team.
Additionally, a member of the histocompatibility lab also attends the weekly desensitization meetings
to discuss HLA results and serves as a resource for the multidisciplinary transplant team.
M. Transplant Pathology – The transplant pathologist provides assessment of biopsy specimens and
histological diagnosis.
N. Other – consults may be obtained from other services (i.e., pathology, psychiatry, hepatology,
radiology, oncology, pulmonary, cardiology, alcohol and drug assessment, etc.) as needed.


IV. COORDINATION

University of Wisconsin Transplant Program

REVIEWED AND APPROVED BY

Kidney Transplant Manager
Operations Director

SIGNED BY



Jill Ellefson, MBA Dixon Kaufman, M.D., PhD
Director, Organ Donation and Transplant Service Line Chair, UW Transplant Program
POLICY & PROCEDURE

Effective Date: December 2011
Revised Date: October 2016

Title: Multidisciplinary Patient Care Team‐ Living
Donor

Policy Number: 4.39