Transplant Centers

Welcome 

If you are a kidney transplant center, we invite you to work with other leading transplant centers to increase the quality, speed and number of living donor transplants in your center. The National Kidney Registry allows transplant centers to register donors and recipients directly in our database and participate in multi-center paired exchanges. Participation delivers the following benefits to transplant centers:

• Facilitates more living donor transplants by overcoming donor incompatibility.
• Provides better outcomes for your patients by improving the compatibility of donor/recipient matches.
• Reduces the wait time for transplants.
• Saves/Improves the lives of your patients.

Contact Information

Contact information and cross match lab requirements for each participating center is posted in our web site below to expedite the match offer, cross match and transplant preparation process. Participating centers can update this information in real time ensuring information is always accurate.

Procedures & Responsibilities

A comprehensive procedures section provides clarity as to the responsibilities and requirements of all parties involved in the paired exchange process. This clarity allows all centers to participate in an efficient manner so that time is not wasted.

Center Login

The center Login, located in the upper left of our web site, provides participating centers access to the Registry database where donor and recipient information can be entered and participants can be activated for matching. No personal information is required (e.g. no, name, phone number, SSN, etc.) so that the hospital’s privacy policy does not slow down the process.

 

 

Participating Centers 

Below is a list of our participating transplant centers. To contact a center click the contact link next to the appropriate center.

Center Name	City	Average Exchange Wait Time (months)	Transplants Facilitated In Past 12 Months	Unmatched Pairs	Total Transplants	% Of Pairs Transplanted	CHIP Patients Transplanted	Contact
California - US
St. Joseph Hospital CA	Orange	N/A	0	0	0	-	0	Contact
St. Vincent Medical Center CA	Los Angeles	N/A	0	0	0	-	0	Contact
Keck Medical Center of USC	Los Angeles	N/A	0	1	0	0%	0	Contact
Lucile Packard at Stanford	Palo Alto	N/A	0	0	0	-	0	Contact
Sharp Memorial Hospital	San Diego	3	8	2	13	87%	3	Contact
UC Davis Medical Center	Sacramento	6	12	6	16	73%	1	Contact
UCSF Medical Center	San Francisco	8	16	10	34	77%	5	Contact
Riverside Community Hospital	Riverside	12	1	1	1	50%	1	Contact
California Pacific Medical Center	San Francisco	12	5	5	18	78%	0	Contact
UCLA Medical Center	Los Angeles	14	17	20	59	75%	1	Contact
Loma Linda Medical Center	Loma Linda	36	1	3	1	25%	0	Contact
Stanford University Medical Center	Palo Alto	84	1	7	9	56%	0	Contact
Delaware - US
Christiana Care Health System	Newark	N/A	0	1	1	50%	0	Contact
Florida - US
Tampa General Hospital	Tampa	5	5	2	5	71%	1	Contact
Illinois - US
University of Illinois MC	Chicago	N/A	0	1	0	0%	0	Contact
Rush University Medical Center	Chicago	N/A	0	4	0	0%	0	Contact
University of Chicago Medical Center	Chicago	0	3	0	3	100%	1	Contact
Loyola University Medical Center	Maywood	2	5	1	17	94%	10	Contact
Indiana - US
Indiana University Health Transplant	Indianapolis	N/A	0	3	0	0%	0	Contact
Maryland - US
Walter Reed National Military Medical Center	Bethesda	N/A	0	1	0	0%	0	Contact
University of Maryland Medical Center	Baltimore	N/A	0	13	2	13%	0	Contact
Massachusetts - US
Brigham and Women's Hospital	Boston	N/A	0	3	0	0%	0	Contact
Massachusetts General Hospital	Boston	12	1	1	1	50%	0	Contact
Missouri - US
Barnes-Jewish Hospital	St. Louis	32	3	8	4	33%	0	Contact
New Jersey - US
Newark Beth Israel Medical Center	Newark	N/A	0	2	5	71%	0	Contact
Our Lady of Lourdes	Haddon Heights	N/A	0	1	3	75%	0	Contact
Robert Wood Johnson	New Brunswick	12	3	3	5	63%	0	Contact
Saint Barnabas Medical Center	Livingston	16	10	13	26	67%	1	Contact
Hackensack University Medical Center	Hackensack	24	1	2	4	67%	0	Contact
New York - US
St. Luke's Transplant Center	New York	N/A	0	0	0	-	0	Contact
New-York Presbyterian Columbia	New York	0	2	0	5	100%	0	Contact
Mount Sinai Medical Center	New York	3	4	1	7	88%	1	Contact
NewYork-Presbyterian/Weill Cornell	New York	9	21	16	63	80%	9	Contact
Montefiore Medical Center	Bronx	12	2	2	7	78%	0	Contact
Ohio - US
Ohio State University Medical Center	Columbus	0	2	0	3	100%	0	Contact
Cleveland Clinic	Cleveland	24	1	2	1	33%	0	Contact
Pennsylvania - US
Lankenau Hospital	Wynnewood	N/A	0	1	0	0%	0	Contact
University of Pennsylvania Hospital	Philadelphia	4	3	1	3	75%	2	Contact
Thomas Jefferson University Hospital	Philadelphia	8	3	2	3	60%	0	Contact
Pinnacle Health Systems	Harrisburg	10	6	5	13	72%	3	Contact
Allegheny General Hospital	Pittsburgh	10	6	5	14	74%	0	Contact
Starzl Transplantation Institute/U Pittsburg	Pittsburgh	36	4	12	4	25%	0	Contact
South Carolina - US
Medical University of S Carolina	Charleston	N/A	0	0	0	-	0	Contact
Tennessee - US
Methodist University Hospital Tenn	Memphis	24	1	2	1	33%	0	Contact
Texas - US
Methodist Hospital, Houston	Houston	0	3	0	7	100%	0	Contact
Utah - US
University of Utah Medical Center	Salt Lake City	8	3	2	7	78%	0	Contact
Intermountain Medical Center	Murray	12	2	2	2	50%	0	Contact
Vermont - US
Fletcher Allen Health Care	Burlington	N/A	0	1	1	50%	0	Contact
Victoria - AU
Royal Melbourne Hospital	Victoria	N/A	0	0	0	-	0	Contact
Virginia - US
Virginia Transplant Center	Richmond	6	6	3	8	73%	0	Contact
Sentara Norfolk General Hospital	Norfolk	12	1	1	1	50%	0	Contact
Washington - US
Seattle Children's Hospital	Seattle	N/A	0	1	0	0%	0	Contact
University of Washington Medical Center	Seattle	24	1	2	4	67%	0	Contact
Wisconsin - US
University of Wisconsin, Madison	Madison	10	16	13	16	55%	6	Contact
Inactive Centers	--	0	1	0	6	0%	0
TOTALS:		14	180	188	403	0%	45

 

NKR Living Donor Evaluation Guidelines 

The purpose of the evaluation and consent of the living donor is to maintain the highest degree of safety and transparency for the living donor. As a baseline, the Amsterdam Guidelines and the UNOS standards will be used for donor evaluations. There may be variances in practice due to availability and accuracy of the various testing methods as well as the differences in medical risk demonstrated in different geographic locations. However, given the fact that the NKR is servicing many geographically dispersed programs, the nuances of the donor evaluations must be communicated between centers once a match offer is accepted. Transplant centers should not contact another center donor or recipient for any purpose. All communications must occur between transplant center personnel. This policy is strictly monitored for the well being of all patients. In addition, other centers must never contact another centers lab for results. All communication must be between coordinators.

Any violations will be brought to the attention of the Paired Exchange Operations Committee for discussion and review.

Basic Evaluation:

1. Complete history and physical
2. Height, weight, BMI
3. BP at two different settings on different days
4. General laboratory to assess:
   1.  hematologic status,
   2. coagulation,
   3. electrolytes,
   4. fasting lipids and glucose
   5. liver status
5. CXR
6. ECG
7. Age appropriate evaluation for cancer

 

Kidney evaluation:

1. Urinalysis with microscopy
2. Urine culture if indicated
3. 24 hour urine for albumin excretion and creatinine clearance
4. Anatomic Testing for anatomy definition
5. If a donor GFR reading comes in at or below 85, the center will perform a nuclear medical GFR test to confirm the donor's GFR is > 80
6. If there is > 10% difference in donor kidney size (between the two kidneys) then the smaller kidney will be offered for donation

 

Infectious disease screening:

1. CMV
2. EBV
3. HIV 1,2
4. HBsAg, HBcAB, HBsAB
5. HCV
6. RPR
7. Tuberculosis
8. Depending upon time of year and location associated risk
   1. Strongyloides
   2. Trypanosoma cruzi
   3. West Nile Virus
   4. Toxoplasmosis

 

Donors at risk for the metabolic syndrome or diabetes:

Suggested evaluation:

1. Uric acid
2. HbA1C
3. Glucose tolerance testing

 

Policy For Ending Chains

In order to maximize the number of transplants facilitated, NKR will end chains according to the following priorities:

1. To a former NKR NDD in need of a kidney transplant.
2. To a recipient who's donor has donated and the recipient does not have a kidney such as when an intended donor becomes ill, an out of sequence swap is executed or when advance donation with informed consent takes place.
3. To a recipient on the wait list of an NKR participating center. The center receiving the kidney will be determined based on net chains started and the number of NDDs active in the NKR system while minimizing the distance kidneys must be shipped. The objective will be to manage net chains started by center within a range of -1 to +3. For the purpose of calculating net chains started, the center that completes the NDD work-up is the center that receives credit for starting a chain.

Children & High PRA (CHIP) Program

The CHIP program helps patients without donors who are either children or are disadvantaged because they are sensitized

• NKR member centers that have net chains started > 0 may enroll up to 30 candidates in the CHIP program.
• Net chains started is the total number of chains that a center starts less the total number of chains a center ends.
• CHIP candidates must be children (18 or younger) or sensitized adults.
• The most likely blood types to find a CHIP match are "AB", "A" and "B" blood types.
• The CHIP program is used as a last resort. The probability of a match dramatically improves when a paired donor(s) are available.

Match Offer Selection Policy

The NKR will select match offers and implement matching strategies according to the following guidelines:

1. When adequate time is available, NKR will select match offers that facilitate the most transplants as quickly as possible.
2. When time is limited (e.g. NDD has aggressive donation deadline, etc.), NKR will select match offers with the greatest probability to make it to transplant within the allotted timeframe. Consideration will be given to factors such as donor pre-selection, donor worked-up, cross match completed, member center OR/surgical availability, coordinator availability, etc.
3. When multiple potential match offers yield equal numbers of transplants, the hardest to match patients will be prioritized while attempting to minimize the "O" donor shortage.

 

Financial Model 

Donor Hospital (providing donor workup and/or nephrectomy) and Recipient Hospital (performing recipient transplant) are transplant centers that desire to promote living donor kidney transplantation through the provision of paired exchange services and hereby agree to the following financial arrangement.

1. General: In all cases the donor shall not be billed for transplant related medical services including donation evaluation, in-patient stay for donation and post donation complications per Medicare standards. Out of state Medicaid/Medi-Cal patients are not covered by this agreement. All claims must be submitted to the Recipient Hospital within 120 days from the last day of service. Acknowledgement is due upon receipt of claims. Claims payment is due as soon as possible and no later than 90 days from the receipt of an accurate claim.
2. Pre-Transplant Donor Evaluation Services: The Donor Hospital shall provide pre-transplant donor evaluation services. The Donor Hospital shall allocate all costs for the donor evaluation to their Medicare cost report. Physicians participating in the donor evaluation shall bill the Donor Hospital.
3. Organ Transportation: Transportation of the donor organ to the recipient hospital shall be coordinated by the Donor Hospital's Organ Procurement Organization who will bill the Recipient Hospital for the costs associated with transporting the organ.
4. Recipient Inpatient Services: The Recipient Hospital shall bill for services as customary with claims submitted to the recipient's insurance. The physicians shall bill the recipient's insurance for services rendered.
5. Donor Complications: If Medicare is primary, physician services shall be billed to Medicare. If Medicare is not primary then physician services shall be billed to the recipient's insurance unless there is a global arrangement. Technical services are billed to the Recipient Hospital.
6. Hospital Donor Nephrectomy: The Donor Hospital shall bill the Recipient Hospital for the donor organ recovery by billing the Recipient Hospital with a copy of their most currently filed Medicare Cost Report, Worksheet D-6, Part I, which will document the cost per day and the appropriate cost to charge ratios along with a worksheet that reduces the Donor Hospital bill from charges to cost. This will document the cost of the case which is the amount to be paid by the Recipient Hospital. (sample worksheet)
7. Physician Donor Nephrectomy: Physicians shall bill the Recipient Hospital or recipient’s insurance for services rendered according to the following:
   • If Medicare is Primary, physicians shall bill Medicare utilizing the recipients Medicare number.
   • If the Recipient Center has a "global" or "case rate" arrangement, the donor physicians shall bill and receive payment from the Recipient Center at 150% of Medicare Participating. Anesthesiology shall bill and be reimbursed at $65.29/ASA unit.
   • If the recipient center does not have a "global" or "case rate" arrangement, the recipient center will work with the donor center to ensure the donor physicians get paid appropriately.

 

 

HLA & Cross Matching 

Accurate HLA testing and cross matching are critical to the success of our program. We require transplant centers to list the following donor antigens and recipient antibodies in our system; A, B, DR, DQ, DP, Bw, Cw, DR51, DR52 and DR53. We require centers to list A, B and DR recipient antigens. To further minimize unexpected cross match failure, all labs have agreed to:

1. Review all match offers to double check the virtual cross match prior to match acceptance. All donor antibody and recipient antigens are in the Excel file attached to the NKR match offers.
2. Acquire the NKR username and password from the transplant center to directly view the current recipient antibodies and correct any mistakes that are in the system.
3. Update recipient antibodies whenever they change, or every 90 days.
4. Provide a written explanation of root cause and corrective action for any live cross match failures.
5. Present root cause and corrective action on the national lab director call held quarterly.
6. Utilize the list of standard antigen and antibody identifiers listed below.
7. In order to ensure a streamlined process for cross matching, the following procedures are utilized:
   1. Once match offer accepted recipient and donor center will communicate to begin cross match process.
   2. Recipient center will notify their lab of cross match and provide all necessary information and paperwork prior to donor blood arriving to lab.
   3. Donor center will draw and ship donor blood to the recipient center/lab. The recipient center is not permitted any contact with donor. This policy is strictly monitored. Donor blood tubes should have the following information on the tubes: donor name, date of birth, social security number, date specimen drawn and initials of technician drawing the blood.
   4. Donor center will notify recipient center when to expect specimen and provide the Fedex tracking number.
   5. Every attempt to have cross matches reported by deadline should be made. If center anticipates a delay in reporting cross match results they should email NKR with revised date.
   6. Final cross matches will follow above protocol and should be scheduled well in advance.

 

A	B	DR	Bw	Cw	DQ	DP	DR-51	DR-52	DR-53
1	7	1	4	1	2	1	Yes	Yes	Yes
2	8	103	6	2	4	2	No	No	No
3	13	4		4	5	3
11	18	7		5	6	401
23	27	8		6	7	402
24	35	9		7	8	5
25	37	10		8	9	6
26	38	11		9		9
29	39	12		10		10
30	41	13		12		11
31	42	14		13		13
32	44	15		14		14
33	45	16		15		15
34	46	17		16		17
36	47	18		17		18
43	48			18		19
66	49					20
68	50					23
69	51					28
74	52
80	53
	54
	55
	56
	57
	58
	59
	60
	61
	62
	63
	64
	65
	67
	71
	72
	73
	75
	76
	77
	78
	81
	82
	2708
	4005

 

 

Shipping Kidneys 

Preparation for shipping living donor kidneys

• The Recipient center/insurance is responsible for costs related to shipped kidneys
• Donor center will send tubes requested by recipient center for confirmatory donor ABO and initial crossmatch and then final crossmatch (if final requested).
• Upon a successful cross match, the following will be provided by the donor center:
  • Donor hospital tax ID number
  • Complete donor workup
  • Hospital address (also on NKR web site)
  • Financial coordinator & transplant administrator contact information (also on NKR site)
• Donor center must register the donor, obtain a UNOS ID number and fill out the LD follow-up forms
• Fax or scan/email when available -prior to surgery:

• Verification of final cross match (recipient center to donor center)

• Donor surgeon will call the recipient surgeon prior to surgery to discuss the case
• Coordinators will discuss/exchange a logistical communication plan prior to the day of surgery  

Supplies for the packaging will include:

• Organ box
• Red biohazard bag inside organ box
• Clear plastic bag with ice inside styrofoam container
• Triple barrier packaged kidney (one of which is jar) – all sterile
• Labeling attached to kidney bag and outside of box with UNOS ID, ABO, Contents (Rt. Kidney or Lt. Kidney)

Contents of the kidney box should include the following:

• 2 ABO verifications each for donor and recipient (if ABO on crossmatch that may considered as first ABO for donor and recipient)
• Crossmatch result of the donor and recipient
• Kidney anatomy (aka Renal Data Sheet)
• Name and DOB of Recipient
• Teidi Donor Registration Page: Please 'print screen' this page (page displays Donor Name, DOB, Donor UNOS ID Number)
•  Donor blood tubes per recipient center request

Outside of box should have an address label that includes the following:

• Destination with full mailing address
• Return address with full mailing address (Originating Transplant Center)

 

Participating Center Requirements 

General

1. Centers will share all participant medical and psychological information to ensure the best possible outcomes for all patients
2. Centers will act with the utmost spirit of cooperation to achieve the greatest number of successful transplants across all participating centers
3. Centers will enter accurate post transplant data so that research can be conducted on patient outcomes
4. Centers will respond to match offers by the match offer deadline which is generally within 1-2 days
5. Centers will educate all transplant recipients and their donors about the benefits of paired exchange
6. When a match offer is accepted, all conditions listed in the match offer are met and accepted
7. When a match offer is accepted, creatinine must be immediately rechecked for predialysis patients and the recipient’s chart must be reviewed for updates
8. When cross matching is completed, donor medical records will be shared with the recipient center
9. Centers are encouraged to place recipients on hold for deceased donor transplants 1-2 weeks before a scheduled exchange
10. Centers will follow the procedures listed on the NKR web site (under the transplant center tab)
11. Centers must ensure all center information entered into the NKR web site is accurate and updated
12. Centers must have cross match results within 10 days of the commencement of the cross match process
13. Center OPOs must be available to ship kidneys and participate on conference calls to plan swap logistics
14. Centers should maintain a formal policy and procedure for evaluating, educating, consenting and listing non directed donors
15. Recipients recipient insurance must be active, medical workups must be up-to-date and predialysis patients must be ready and willing to accept a transplant
16. Centers should maintain polices and procedures to reflect forethought to the process of identifying, educating, and listing pairs
17. Donor and recipient medical and psychological evaluations will be determined by the participating center
18. A formal patient education and consenting process should be in place to facilitate a well planned and successful exchange program
19. Donor pre operative lab studies (CMP, CBC, UA, C&S) must be completed at least 2 weeks prior to the scheduled surgery date to insure donor can proceed
20. All donors will need to have two(2) ABO typings including sub typing where appropriate before entry into NKR.

Coordinators

1. Must have primary and backup coordinators identified with cell numbers entered on the web site (only available to NKR staff)
2. Primary or backup coordinators must be available 24x7 the day before and the day of a swap
3. Primary or backup coordinators must respond same day (email or phone) during business hours
4. If a pair becomes unavailable to participate in a swap (e.g. recipient sick), that pair must be immediately deactivated in the NKR system

HLA Laboratories

1. The NKR standard donor antigens and recipient antibodies listed on the NKR web site must be accurately entered for participants
2. Experienced Lab personnel must review all match offers with the goal to achieve 100% virtual cross match accuracy
3. If a center fails a live cross match, the lab director must email a written explanation to NKR describing the cause of the cross match failure
4. If a center fails a live cross match, appropriate corrective action must presented by the lab director on the NKR national lab director call for peer review
5. Every A blood type donor must be sub-typed for A1 and non-A1 status

Administration

1. Must use the NKR standard financial model posted on the NKR web site to facilitate cost  reimbursement between transplant centers
2. Must not accept a match offer if there is any concern about making enough profit on the transplant services
3. Cannot withdraw from an exchange for financial reasons after the cross match tests are completed

Surgeons

1. Must speak directly with the other surgeon(s) in the swap prior to and the day of surgery to communicate anatomy and other relevant medical issues
2. Must plan to schedule the OR for paired exchange surgeries with 3 weeks notice
3. Must have laparoscopic donor surgical capability

 

 

The CHIP program helps patients without donors who are either children or are disadvantaged because they have high PRAs

• NKR member centers that have net chains started > 0 may enroll up to 30 candidates in the CHIP program
• Net chains started is the total number of chains that a center starts less the total number of chains a center ends
• CHIP candidates must be children (18 or younger) or adults that have a PRA score > 50%
• The most likely blood types to find a CHIP match are "AB" and "A" blood types. Sometimes "B" candidates can be matched, but it is rare