Member Center Requirements

The following requirements are for all NKR Member Centers.

  1. Routine
    1. Member Centers shall not have forecasted net chains started less than 0.
    2. Member Center’s 30 Day Moving Average Pre-select % is at or above 95%.
    3. Member Center’s Data Compliance is at or above 99% with no more than twenty total items outstanding.
    4. Member Centers do not reverse pre-selects after a match is offered.
    5. Member Centers shall have surgical availability to accommodate Tuesday, Wednesday, Thursday, and Friday surgery dates with three weeks advance notice. Due to the high volume of NKR activity, one surgical date decline per month will be waived for Partner Centers.
    6. Member Centers shall not cause avoidable swap failures or safety issues.
    7. Member Centers must report cryo XM results by 15:00 ET on the fourth business day from the day the cryo cells are received. (e.g. If the cryo cells arrive on Tuesday, the results must be recorded in the NKR no later than 15:00 ET Friday).
    8. Member Centers must respond to all requests for donor review within 2 business days.
    9. Member Centers must upload Serology results to the NKR site at least 6 calendar days prior to the donor’s target surgery date – this excludes internal non-voucher chain end positions and positions that were offered 14 days or less before surgery date. E.g. if a donor surgery is scheduled for a Tuesday, the serology results must be uploaded no later than Wednesday of the prior week.
    10. All Routine Member Center Requirements are assessed at month end.
  2. General
    1. Centers shall share all relevant information to ensure the best possible outcomes for all swap participants.
    2. Centers shall act with the utmost spirit of cooperation to achieve the greatest number of successful transplants across all member centers.
    3. Centers shall accommodate remote donation for both the donor and patient.
    4. Centers shall accommodate standard voucher donation.
    5. Centers shall ensure all information entered into the NKR web site is updated and accurate.
    6. Centers shall have cryo preserved cells on hand for all paired donors.
    7. Centers must accept cryo samples for Exploratory & Screening XMs.
    8. Centers shall have CT scans and donor charts uploaded to the NKR system for all paired donors.
    9. Centers shall ensure swap participants are ready to go to surgery once they are activated in the NKR system.
      1. If a pair becomes unavailable to participate in a swap (e.g. patient sick), that pair must be immediately deactivated in the NKR system.
      2. If a donor is travelling internationally or expects to be unavailable for blood draws for a period of a week or more, they must be deactivated in the NKR system until they are once again available for a blood draw.
    10. Centers shall enter accurate post-transplant data so that research can be conducted on recipient outcomes.
    11. Centers shall not contact another center’s donor, patient or lab for any purpose.
    12. Centers shall immediately request an exploratory cross match if there is a reasonable chance of an unacceptable cross match with a potential donor.
    13. Centers shall provide the NKR, upon request, a root cause and corrective action plan within one business day of the request.
    14. Centers shall, prior to a swap kickoff, run back-up lists for both sides of the swap in the event that a donor kidney removed at your center cannot be shipped and must be used at your center or your center receives a kidney and your patient is unable to go to surgery.
    15. Centers must complete the NKR organ packaging checklist and ensure a copy of the organ packaging checklist is shipped with the organ in order to comply with CMS regulations.
    16. Centers involved in swaps shall have proper kidney packaging supplies on hand and a trained organ preservationist on call to pack the kidney in case the kidney is shipped back to the donor center.
    17. Centers shall request information using the “REQUEST DONOR INFO” feature. The Donor Center must enter the requested information into the donor profile and notify the requesting center that the requested information has been added to the donor profile within 1 business day of receipt of the request.
    18. Donor center must register the donor and obtain a UNOS Donor ID number.
    19. Centers shall have laparoscopic donor surgical capability.
    20. Centers shall communicate to all donors that the expected turn-around time for a blood draw request is one business day.
    21. Centers should perform a wellness check on both the donor and patient within 24 hours of scheduled surgery. The minimal requirement for the wellness check is a phone call to the donor and patient confirming they are healthy and ready to move forward with the scheduled surgery.
    22. Centers are encouraged to place patients on hold for deceased donor transplants, once cross matching commences.
    23. Any Donor, whose paired recipient was transplanted via a non NKR swap, is not eligible to participate in the Voucher Program.
    24. Recipient Centers shall email a case report within 48 hours to NKR and the donor center when a swap kidney is NOT transplanted into the intended patient such as when a kidney is discarded, when a kidney is transplanted into a patient other than the intended patient, etc. The case report shall include all information needed to satisfy the donor center’s regulatory reporting requirements.
    25. When arranging a loop swap (no NDD or BD), all donor surgeries shall be scheduled on the same day and if a red-eye flight is used in the loop, the patient receiving the kidney from the red-eye flight will be scheduled for surgery the day following the donor surgeries.
    26. Member Center’s Earliest Organ Pickup Time is 10:00 or earlier.
    27. Member Center’s Latest Organ Delivery Time is 18:00 or later.
  3. Coordinators
    1. Primary and backup coordinators shall:
      1. Be identified with cell numbers entered on the web site.
      2. Respond same day (email or phone) during regular business hours.
      3. Be available 24×7 the day before, and the day of a swap.
      4. Be available for conference calls (e.g. logistic calls, kickoff calls, etc.).
      5. Monitor the GPS beacon for incoming shipped kidneys as outlined in the GPS Tracking section.
    2. If an Exchange Coordinator becomes aware of a situation that puts the swap at risk he/she must immediately send an email to Member Services with notification of the situation and then contact the NKR Swap Manager via phone. If the Swap Manager cannot be reached via phone the Exchange Coordinator must alert their NKR Center Liaison or any other member of the NKR staff.
    3. If a coordinator or center representative is not present on a kickoff call, and the risk notifications outlined in this section have not been satisfied, the NKR will proceed with the swap as scheduled.
    4. If a center experiences an issue that is reported in the quarterly swap failure report, the primary or backup coordinators must attend the National Coordinator call to review the root cause and corrective action related to the swap failure.
  4. Surgeons
    1. Donor and recipient surgeons at a Member Center shall proactively organize their schedules to ensure surgical capacity is available for KPD procedures on Tuesdays, Wednesdays, Thursdays and Fridays with 3 weeks advance notice.
    2. The donor surgeon must call the recipient surgeon within an hour after completion of the donor nephrectomy. If the donor surgery went well and there are no concerns, and the recipient surgeon is not available, a voice mail will suffice. If there are concerns, a second attempt should be made to reach the recipient surgeon. If the second attempt fails, then the recipient center coordinator must be contacted to pass along the information. The surgeons must speak when both are available.
  5. Match Offers
    1. When a match offer is received, the following communications shall take place:
      1. Center contacts both donor and patient to ensure pair is ready for surgery.
      2. Center reviews the virtual cross match & CT scan on NKR site.
      3. Center records match offer decision in NKR site.
    2. Centers shall respond to match offers by the match offer deadline which is generally within one business day of the offer.
    3. When a match offer is accepted, the pair must be immediately deactivated in all other exchange programs, including internal programs.
    4. When a match offer is accepted, the patient’s chart must be reviewed for updates and creatinine must be immediately rechecked for predialysis patients.
    5. Centers are encouraged to deactivate patients in the deceased donor system immediately following the logistics calls for NKR swaps.
    6. Any known potential swap risk must be communicated to NKR immediately via email and reiterated on the logistics and kickoff calls.
  6. HLA, Cross Matching & Serology Tests
    1. Centers shall accurately enter all donor and patient antigens, and all patient avoids including low level DSA’s.
    2. The NKR provides confirmatory ABO typing for all donors, we also include subtype for A, and AB donors.
      1. If a discrepant ABO or subtype is reported between the center and NKR then it is the responsibility of the donor center to retest the donor and notify NKR of the results. For any donor listed as an unknown subtype the NKR will determine the subtype and update the donor profile.
    3. The NKR provides confirmatory HLA typing, including enhanced resolution typing.
    4. When new pairs are first made exportable, the antibody screenings used to determine the avoids shall be current (within 30 days).
    5. Centers shall conduct antibody screenings every 90 days for sensitized patients and update the avoids appropriately.
    6. Recipient centers are expected to report XM results for Cryo preserved samples no later than 15:00 ET on the fourth business day from the day the cryo cells are received. (e.g. If the cryo cells arrive on Tuesday, the results must be recorded in the NKR no later than 15:00 ET Friday)
    7. When centers receive a potential match email centers shall record clearance of potential matches according to the following procedure:
      NKR Potential Match Flowchart Timeline
    8. Donor blood for serology tests must be shipped to the NKR lab no later than 9 days before surgery and the test results uploaded to the NKR site no later than 6 days prior to the donor’s target surgery date to ensure the donor can proceed.
    9. Member Centers must have the ability, through their own or NKR lab, to provide serology test results in three calendar days or less.
    10. If a center reports an unacceptable cross match, the lab director shall review the root cause and corrective action plan on the National Lab Director call.
    11. The NKR uses three types of Cross Matches:
      1. Exploratory cross matches are requested by a recipient center prior to a match offer to confirm a donor is compatible with a sensitized recipient.
      2. Screening cross matches are required once all match offers in a swap are accepted; this cross match will be commenced by NKR.
      3. Final cross matches are requested by the recipient center 1-2 weeks prior to surgery (cryo preserved samples cannot be used for Final cross matches).
    12. When fresh blood is used, the following cross matching procedures are utilized according to the timeframes in the flowchart below:
      1. Donor center draws and ships donor blood to the recipient center/lab.
      2. Donor blood tubes are labeled according to the instructions.
      3. Recipient center receives the blood, performs the cross match and records the results on the NKR web site.
    13. When cryo preserved NUCS are used, the following cross matching procedures are utilized according to the timeframes in the flowchart below:
      1. Donor center ships cryo preserved NUCS to the recipient center/lab.
      2. Cryo preserved NUCS are labeled according to the instructions.
      3. Recipient center receives the NUCS, performs the cross match and records the results on the NKR web site.
      4. NUCS for exploratory cross matching should only be used for the cross match so that multiple NUCS are not needed. Exploratory cross match testing should not include other testing such as:
        1. Donor typing
        2. Multiple Sera
        3. Multiple Platform
        4. Cytotoxicity
        5. Pronase
      5. When using cryo for a screening crossmatch additional NUCS may be requested, if needed, to perform additional tests.
        NKR Crossmatch Flowchart
    14. Shipping Kidneys
      1. To reduce the inherent shipping risks related to connecting commercial flights, an on board courier must be utilized for all connecting flights.
      2. Packaging supplies include:
        1. Organ box
        2. Red biohazard bag inside organ box.
        3. Clear plastic bag with ice inside a Styrofoam container.
        4. Triple barrier packaged kidney (one of which is jar) – all sterile.
        5. Labeling attached to kidney bag.
      3. Kidney box must include the following:
        1. A UNOS label filled out according to UNOS standards on the outside of the box.
        2. NKR supplied GPS Device, unless the kidney is travelling via On Board Courier.
        3. NKR supplied Human Organ stickers affixed to all 6 sides of the box before other labels are applied so that other labels are fully visible, NKR Stickers will be supplied in the GPS box.
        4. Destination mailing address on the outside of the box (recipient center).
        5. Return address on the outside of the box (donor center).
        6. Two ABO verifications for the donor.
        7. Kidney anatomy (aka Renal Data Sheet).
        8. Complete Donor Medical Chart.
        9. Teidi Donor Registration Page: Please ‘print screen’ this page (page displays Donor Name, DOB, Donor UNOS ID Number).
        10. Donor blood tubes per recipient center request packaged so that they do not come in contact with the ice.
        11. Copy of the completed NKR packaging checklist.
        12. Kidney must be 100% covered in ice.
      4. If the packaging provider does not provide the packaging services adequately then they will not be paid for the inadequate packaging service. Inadequate service includes, but is not limited to, not responding to a RCCAP request within 2 business days.
      5. GPS Tracking:
        1. Donor Centers will receive a GPS device, from NKR approximately 1-5 business days before donor surgery.
        2. The GPS device must be packed on top of the ice or inserted between the shipping containers, unless an On Board Courier is transporting the kidney.
        3. If the kidney is being transported via On Board Courier:
          1. The GPS device should be given to the driver, not packed in the box with the kidney.
          2. A letter should be given to the courier explaining what is in the box, as well as instructions not to open the box. Click here for a sample letter.
        4. Coordinators at both the donor and recipient centers will receive the following confirmation emails throughout each step of the journey, including a link to the location of the GPS beacon. Once airborne at an altitude of approximately 5,000 feet and higher, the Last Known Location will no longer update.
          1. Pick up Confirmation
          2. Tendered to Airline Confirmation
          3. Flight Departure Confirmation
          4. Airline Recovery Confirmation
          5. Delivery Confirmation
        5. It is the responsibility of the recipient center coordinator to monitor the GPS device.
        6. The coordinator must contact the swap manager immediately if there are any inconsistencies between the GPS readings and logistics plan.
        7. Recipient Centers will receive pre-paid return packaging from NKR for the return of the GPS.
        8. The GPS device must be sent back to NKR within one business day of recipient surgery.