Policy: Kidney/Pancreas Pre-Transplant: Kidney Transplant Candidate Selection Criteria
Statement: Activation date: 1/28/03
Affected Department: Emory Kidney Transplant Program
Vision Strategy: Patient Care
Policy Statement: Determination of candidacy for renal transplant is based upon specific program selection criteria.
Candidates must have chronic renal failure (CRF)(Stage IV or V) or End-Stage Renal Disease (ESRD), and desire a
renal transplant. Candidates are considered based on 1) their overall health status, 2) sufficient family and social
support systems, 3) an ability to obtain transportation to and from the transplant center, and 4) an ability to purchase
and take prescribed medications after transplant, to be reasonably assured s/he can successfully manage the posttransplant treatment regime. There are no absolute age criteria. Patients with CRF may be referred and evaluated;
however a candidate must be dialysis dependent or have a creatinine clearance of < 30cc/min before he/she will be
placed on the UNOS waiting list.
Basis: This procedure is necessary to ensure that effective and efficient care is provided to all patients who are
referred to the Emory Transplant Center’s Kidney Transplant Department for a potential kidney transplant.
Administrative Responsibility: Section heads, physicians, practitioners, and staff are responsible for compliance
with this policy.
Scope/Procedure:
The Emory Kidney Transplant Program will evaluate candidates who meet the required criteria. Each candidate will
be considered and if necessary, referred to UNOS for assistance with referral to other centers with expertise in the
treatment of specific diseases not currently treated by our team.
Not a candidate for evaluation:
BMI > 38
Active drug abuse (cocaine, IV drugs, methamphetimines )
If drug abuse is mentioned on referral form or in H&P, please contact dialysis center or primary nephrologist and Pt
to determine if Pt is still using.
Smoking Diabetics (exception if Pt has recently quit smoking or is in the process of quitting and down to a few
cigarettes a day & making great effort to stop)
History of cancer with metastatic disease
Further information will need to be obtained on the following Pts before being scheduled for evaluation:
History of cancer with no metastatic disease:
Pt must have completed all treatment.
Please obtained pathology report, date of diagnosis and date of completion of treatment.
Pt may be evaluated and possibly listed status 7 until appropriate waiting time from diagnosis has accumulated.
History of abdominal aortic surgery or any vascular surgery involving pelvic vessels (iliacs, femoral):
Obtain operative reports and have reviewed by Dr. Pearson prior to scheduling evaluation.
Selection Criteria:
Absolute Contraindications
There are many situations in which renal/pancreas transplantation may not be appropriate. The following list is
meant only as a guide. The transplant team will always be willing to perform an initial review on any patient if there
is a doubt as to candidacy. Absolute contraindications to immediate transplant or active listing for transplant include:
1- Active infection. This may include bacterial, viral, and fungal infections.
2- Previous aortofemoral graft reconstruction for peripheral vascular disease.
3- Severe mental disability without adequate social support to manage post transplant regime.
4- Severe irreversible extra non-renal and organ disease, such as respiratory disease, cardiac disease and hepatic
disease.
5- Severe active vasculitis or other autoimmune disorders.
6- Current untreated malignancy other than non-melanoma skin cancer.
7- General medical condition and/or functional status that makes the risk of
Transplant greater than the potential benefit.
Relative Medical Contraindications
The following list serves as a guideline. Every candidate referral with a relative contraindication will be reviewed
with the transplant team before a final candidacy decision is made.
1- Serious medical problems that may be reversible.
2- Organic neurological disorders, psychiatric disorders, and/or drug addiction that will, in our opinion, significantly
impair the candidate’s ability to manage the post transplant regime.
3- Severe peripheral vascular disease.
4- Malignancy within the last two to five years other than non-melanoma skin cancers. Every candidate with a
previous malignancy will be evaluated individually based on surgery notes, pathology reports, and cancer treatment
records.
5- Moderately severe or severe cardiac disease, including ischemic myocardial disease, congestive heart failure,
valvular disease and myopathies.
6- Chronic active inflammatory or infectious diseases.
7- Obesity or malnutrition to the extent that this factor significantly impacts surgical risk and life expectancy. Refer
to Emory Policy on BMI.
8- Chronic upper respiratory disease.
9- Uncorrected lower urinary tract abnormalities.
Additional Information
Candidates with most disease etiologies for ESRD are considered as candidates for transplant. For example, patients
with metabolic disorders such as diabetes, Alport’s syndrome, cystinosis, gout, amyloidosis and oxalosis may be
considered candidates. Individuals with inactive systemic lupus erythemotosis and sickle cell are also considered be
to generally acceptable potential recipients.
Candidates with ESRD resulting from focal sclerosing glomerulonephritis, IGA nephropathy, dense deposit disease,
anti-GMB disorders and oxalosis among others, are at risk for the development of these disease in the transplanted
graft. However, this should not exclude the patient from consideration as an acceptable renal transplant candidate. A
decision to accept a high risk candidate will be made only after the patient and referring physician have been fully
informed of the potential risks of transplantation and both decide that the risk of chronic dialysis significantly
outweighs the risk of transplantation.
Relative Non-Medical Contraindications
The following list serves as a guideline. Every candidate referral with a relative contraindication will be reviewed
with the transplant team before a final candidacy decision is made.
1. Inability to provide adequate psychosocial support plan
2. Inability to provide adequate financial plan for provision of
medications and the cost associated with post-transplant care per policy
3. Failure to follow No Show/Cancellation policy
4. Failure to complete required testing and/or transplant plan within program
timeframe guidelines
5. Gross non-compliance
6. Recipient candidate does not desire a transplant
7. Failure to maintain contact with the transplant center
Approved by: Kidney/Pancreas Transplant Leadership Group
Approval Dates: 8/5/06, 12/15/06, 2/6/08 , 2/1/2012
Revision Date: 3/15/11, 6/30/11, 2/1/1012