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Patient Evaluation and Selection Process (3.33)

Patient Evaluation and Selection Process (3.33) - Policies, Administrative, UWHC, Department Specific, Transplant, Transplant - Solid Organ

3.33



POLICY & PROCEDURE
Effective Date: Dec 2011
Revised Date: June 2015 Title: Patient Evaluation and Selection Policy Policy Number: 3.33

Page 1 of 3
I. PURPOSE

The purpose of this policy is to provide standards of care for a multidisciplinary team to ensure that
transplant patients are being evaluated and selected for transplantation with a consistent, high level
standard of care.

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, United Network of Organ Sharing ("UNOS"),
and Centers for Medicare & Medicaid Services ("CMS") as well as State and Federal laws.

III. FORMS

The following criteria and guidelines can be found on the “related tab” for this policy:

Kidney Evaluation Guidelines
Kidney Selection Criteria
Heart Evaluation Guidelines
Heart Selection Criteria - Tranplant
Heart Selection Criteria - Retranplant
Heart/Lung Selection Criteria
Lung Evaluation Guidelines
Lung Selection Criteria
Liver Evaluation Guidelines
Liver Selection Criteira
Pancreas Evaluation Guidelines
Pancreas Selection Criteria


IV. PROCEDURE
A. Patient is referred to the UW Transplant Program.
B. Demographic information is obtained and a UW medical record number is assigned through
Registration.
C. Medical records are obtained and reviewed.
D. Formal evaluation visit with the UW Transplant Team is scheduled, as appropriate



POLICY & PROCEDURE
Effective Date: Dec 2011
Revised Date: June 2015 Title: Patient Evaluation and Selection Policy Policy Number: 3.33

Page 2 of 3
1. At the evaluation appointment the patient will be seen by the organ specific
multidisciplinary team which may include Transplant Surgeon or Physician, Transplant
Coordinator, Social Worker, Financial Counselor, Certified Dietician and other disciplines
as necessary. See Policy 3.39 for full description and participation of each member of the
multi-disciplinary team.
2. Appropriate consent forms are signed during the evaluation process (See Policy 3.06).
3. Organ specific evaluation guidelines are available for each program (see Forms). In
general (unless otherwise clinically indicted), tests/consults are deemed current until
time of listing and are then performed according to Policy 3.12 Managing Patients on
the Waiting List.
E. Upon completion of the evaluation, each patient will be presented at a multidisciplinary meeting
and a determination will be made about the candidacy for transplantation, based on organ
specific selection criteria.
1. In exceptional circumstances (i.e. urgency of listing) a patient may be reviewed with
appropriate members of the multi-disciplinary team and listed (if selection criteria are
met) and then presented at the next multi-disciplinary team meeting.
F. For patients who are determined to be candidates for transplantation:
1. Patient is added to the UNOS waitlist per Policy 3.09, Waitlisting Policy
G. Patient is managed as described in Policy 3.12, Managing Patients on the Waiting List. For
patients who are determined not to be candidates for transplantation:
1. Written correspondence is provided to the patient within 10 calendar days, regarding
this decision and documenting the criteria used for the denial.
2. The referring physician, the dialysis unit (if applicable) are sent a copy of this
correspondence with additional documentation as outlined in UNOS Bylaws Appendix B
Section II, and selection criteria, if requested.
V. COORDINATION

University of Wisconsin Transplant Program

VI. REVIEWED BY

Kidney Transplant Manager
Liver Transplant Manager
Heart and Lung Transplant Manager
Operations Director





POLICY & PROCEDURE
Effective Date: Dec 2011
Revised Date: June 2015 Title: Patient Evaluation and Selection Policy Policy Number: 3.33

Page 3 of 3
VII. SIGNED BY

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