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Policies,Administrative,UWHC,Department Specific,Transplant,Living Donor

National Paired Kidney Exchange Program (6.11)

National Paired Kidney Exchange Program (6.11) - Policies, Administrative, UWHC, Department Specific, Transplant, Living Donor

6.11



POLICY & PROCEDURE
Effective Date: March 2011
Revised Date: August 2013
Title: National Paired Kidney Exchange Program Policy Number: 6.11

Page 1 of 5
I. PURPOSE

The purpose of this policy is to provide a consistent process to allow the University of Wisconsin
Hospital & Clinics (UWHC) Kidney Transplant Program to participate in the Paired Kidney Exchange
("PKE") Program. This process will maximize the chance of a well-functioning graft and minimize the
risk to the donor and recipient.

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"), the United Network of Organ Sharing ("UNOS") and the Centers of Medicare and
Medicaid Services ("CMS").

III. FORMS

Living Donor Kidney Transplant Paired Kidney Exchange Consent (Rev. 11/24/10)
National PKE Program Organ Shipping Checklist
ABO Verification Form

IV. ADMINISTRATIVE PROCEDURE

A. Anonymity will be maintained between all participants in paired kidney exchange transplants.

B. If all donors and recipients involved in paired kidney exchange transplants express a desire to
meet, their contact information will be shared to allow communication within the group. This
information will only be shared after surgery is completed and consent is obtained from all
participants in the group.

C. UWHC Kidney Transplant program will notify the national kidney paired exchange program(s) of
any changes in recipient/donor pairs so the database remains accurate.

D. Recipient and donor follow-up care is the responsibility of the center that performed the
operation on each patient.

E. Completion of United Network for Organ Sharing (UNOS) follow-up forms for the donor is
currently the responsibility of the actual recipient's transplant hospital. Therefore, in



POLICY & PROCEDURE
Effective Date: March 2011
Revised Date: August 2013
Title: National Paired Kidney Exchange Program Policy Number: 6.11

Page 2 of 5
accordance with applicable law and the Health Insurance Portability and Accountability Act
(HIPAA), and consent/release forms executed by the donors and recipients, the intended
recipient hospital will share all necessary and relevant data about the donor's status with the
actual recipient hospital. However, the expectation will be that the transplant center
performing the donor nephrectomy will notify UNOS that they will take responsibility for
completion of the donor follow-up forms, as well as donor follow-up care.

a. Regulatory Requirements: In order to comply with Centers for Medicare and Medicaid
Services (CMS) and UNOS requirements, the following procedures will be followed.
b. For those donors originating at UWHC, the following documents will be maintained in
the donor's electronic medical record (HealthLink) and forwarded on to the transplanting
center:
i. Living Donor Agreement Form
ii. Living Donor Selection Review Form
iii. 2 ABO results using source documents
iv. Evaluation results, including
1. Surgical evaluation
2. Medical evaluation
3. Pertinent diagnostic and lab results
4. Psychological evaluation
5. Living donor advocate evaluation
c. For those donors originating from a center other than UWHC who will donate to a
recipient at UWHC, documentation of the following requirements will be obtained from
the donor center and scanned into HealthLink for that donor:
i. Documentation the donor meets specified selection criteria
ii. Two ABO results using source documents
iii. Evaluation results, including:
1. Surgical evaluation
2. Medical evaluation
3. Pertinent diagnostic and lab results
4. Psychological evaluation and/or social work / donor advocate
5. Living donor advocate evaluation

V. CLINICAL PROCEDURE

A. Evaluation and Selection
1. Prospective donors and recipients originating at UWHC will undergo the evaluation
process as outlined in Policies #4.33, "Patient Evaluation Process" of Living Kidney



POLICY & PROCEDURE
Effective Date: March 2011
Revised Date: August 2013
Title: National Paired Kidney Exchange Program Policy Number: 6.11

Page 3 of 5
Donors, and policies #3.33 "Patient Evaluation Process" for Kidney Transplant Recipients
prior to being enrolled in a national PKE program.
2. Prospective donors and recipients must meet the selection criteria outlined in Policies
#4.07, "Selection Criteria for Living Kidney Donors and #3.07, "Selection Criteria for
Kidney Transplant" prior to being enrolled in a national PKE Program.
B. Once prospective donors and recipients have met selection criteria and are approved by the
multidisciplinary patient selection team and it has been determined that they are incompatible,
all participants (potential donors and recipients) for the PKE program will complete the following
forms:
1. The "Authorization for Release of Health Information" form in which the potential
recipient or donor will agree that their name, various demographic and laboratory data
will be shared with the PKE registry and other collaborating institutions for the purposes
of participating in the PKE.
2. The HLA lab and PKE Coordinator will enter unacceptable antibodies into the kidney
registry.
3. "Kidney Paired Donation Patient Consent Form"-this information will be reviewed with
the recipient and/or donor and scanned into the patient's EMR.
C. Management of Pairs while awaiting PKE Transplant
1. Since expected waiting times for PKE matching can vary significantly, the management of
the recipient patient waiting for transplant will be done in accordance to policy #3.12,
Managing Patients on Wait List.
2. In addition the following information should be verified every 6 months:
a) Address and phone number
b) Change in insurance
c) Change in dialysis treatment
d) Change in nephrologists or dialysis unit
e) Hospitalizations or illness
3. PKE Matching
a) The UWHC PKE coordinator will provide the necessary information to the PKE to
begin the process. The PKE will analyze the list and identify the most feasible
matches in terms of pairs most likely to have a negative cross-match without
requiring desensitization.
b) Upon acceptance of the cross match, the potential recipient will be put on "hold"
on the deceased donor kidney waitlist.
c) When potential pairs are identified, cross-matching will occur at the labs of origin
for each recipient. If the recipient is from a sharing center, then the sharing
center will perform the cross-matching of their recipient with the donor from the



POLICY & PROCEDURE
Effective Date: March 2011
Revised Date: August 2013
Title: National Paired Kidney Exchange Program Policy Number: 6.11

Page 4 of 5
PKE Registry or vice versa. Each lab will follow existing standard guidelines for
cross matching donors and recipients for living donor transplantation.
4. Scheduling/Evaluation
1. Once a viable paired donation is identified, complete medical information about each
donor will be shared between UWHC and the other receiving or providing transplant
center.
2. For medical records of potential donors or candidates sent to UWHC, a medical record
number (MRN) will be generated and these records will be scanned into HealthLink.
3. If a center requests additional testing to be conducted on the kidney donor, the test(s)
will be conducted at the donor center and billed to the requesting hospital.
4. Pre-operative clearance for the donor will be obtained at the donor center. The donor
information will also be presented at the recipient center to ensure they meet the
recipient center's criteria for approval.
5. If there is any problem with donors or recipients of the paired kidney exchange,
(medical, psychosocial, etc) prior to the date of surgery, the surgery will be cancelled.
D. Timing of Transplants and Transport of Kidneys
1. Donors will have the option of traveling to the recipient center or remaining at their
intended recipient center. This preference will be indicated at the time of registration of
the pair in the PKE database. If the donor travels to the actual recipient center, the
donor will be assigned a coordinator, surgeon and nephrologist who will ensure that
their needs are met at the recipient transplant center.
2. If the donor elects to remain at their intended recipient center, the donor kidney will be
transported to the center where the actual recipient is undergoing transplant.
3. Nephrectomies will be scheduled and agreed upon by all involved transplant centers.
4. The kidney will be transported in the most expeditious manner, i.e. ground courier,
charter air, etc. The receiving transplant center will be responsible for the cost of
shipping and thus will determine the transportation mode. The logistics of kidney
transport will be arranged well in advance of the transplants. Kidneys will be packaged
and shipped according to UNOS Policy:
a) The "ABO Verification Form" will be included and shipped with the kidney.
b) Recipient procedure will be timed according to the expected time of arrival of the
donor kidney.
c) If paired exchange surgery is not completed at either center, neither transplant
center is liable for the fact that one recipient's transplant was not completed.

VI. BILLING
A. All charges incurred in assessing the donor's anatomical, physiological and psychosocial fitness
for donation will be billed to intended recipient's insurer or receiving transplant center. If the



POLICY & PROCEDURE
Effective Date: March 2011
Revised Date: August 2013
Title: National Paired Kidney Exchange Program Policy Number: 6.11

Page 5 of 5
recipient has Medicare coverage, the donor evaluation costs will be added to the donor center's
Medicare cost report.
B. The donor nephrectomy hospitalization, hospital, and professional fee will be billed to the
receiving transplant center or recipient's insurer. Costs will be reimbursed according to the
Medicare fee schedule for Medicare patients or per the terms specified by the NKE program.
C. Similarly, all charges incurred in immunogenetic testing conducted to confirm or rule out match
will be billed to the intended recipient's insurer or hospital/transplant center.
D. If the center performing transplant requests additional testing on the donor, the charges of
these tests will also be billed to the intended recipient's insurer or hospital/transplant center.
E. Transportation of the kidneys between centers will be paid for by each receiving transplant
center.
F. In the event there is a complication with a donor, post donation services will be the
responsibility of the intended recipient's insurer or transplant center performing the
nephrectomy.

VII. COORDINATION

University of Wisconsin Transplant Program


VIII. REVIEWED BY

Transplant Service Line Policy and Procedure Committee 8/2013

IX. SIGNED BY


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