Member Center Requirements

  1. Routine: Member Centers shall:
    1. Not cause avoidable swap failures or safety issues.
    2. Not reverse pre-select acceptances after a match is offered.
    3. Respond to all requests for donor review within two business days.
    4. Not have a Net Chains Started (“NCS”) less than zero (0).
    5. Have a 30-day moving average pre-select score above 95%.
    6. Have a data compliance score above 99% with no more than twenty (20) total items outstanding.
    7. Have surgical availability to accommodate Tuesday, Wednesday, Thursday and Friday surgery dates with three weeks advance notice. Due to the high volume of NKR surgical activity, one surgical availability decline per month will be waived for Partner Centers.
    8. Report cryo XM results by 15:00 ET on the fourth business day from the day the cryopreserved cells are received. (e.g., If the cryopreserved cells arrive on Tuesday, the results must be recorded in the NKR no later than 15:00 ET Friday).
    9. Upload serology results to the NKR site at least six calendar days prior to the donor’s target surgery date (e.g., if a donor surgery is scheduled for a Tuesday, the serology results must be uploaded no later than the prior Wednesday). This excludes internal one-ways and matches offered less than 14 days before the surgery date.
  2. General: Member Centers shall:
    1. Cooperate to achieve the greatest number of successful transplants.
    2. Ensure all information entered into the NKR is updated and accurate.
    3. Share all relevant information to ensure the best possible outcomes.
    4. Accommodate remote donation.
    5. Have CT scans and donor charts uploaded to the NKR system for all donors.
    6. Have cryopreserved donor cells on hand at the NKR lab for all donors.
    7. Accept cryopreserved donor cells for exploratory and screening crossmatches.
    8. Immediately request an exploratory crossmatch if there is a reasonable chance of an unacceptable crossmatch.
    9. Ensure swap participants are ready to go to surgery when activated in the NKR.
    10. Not contact another center’s donor, patient or lab for any purpose.
    11. Provide a root cause and corrective action plan to the NKR within one business day of the request.
    12. Run back-up lists, prior to a swap kickoff, for both sides of the swap in the event that a donor kidney cannot be used by the intended NKR recipient.
    13. Utilize the NKR’s Streamlined Serology Service (this excludes internal one-ways and matches offered less than 14 days before the surgery date).
    14. Complete the NKR organ packaging checklist and ensure a copy of the organ packaging checklist is shipped with the organ, to comply with CMS regulations.
    15. Have proper kidney packaging supplies on hand and a trained organ preservationist on call to pack the kidney in case the kidney must be shipped back to the donor center.
    16. Request missing donor information using the “REQUEST DONOR INFO” feature. The donor center shall 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 one business day of receipt of the request.
    17. Register the donor and obtain a UNOS donor ID number.
    18. Have laparoscopic donor surgical capability.
    19. 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.
    20. Email a case report within 48 hours to the NKR and the donor center when a swap kidney is not transplanted into the intended patient, including all information needed to satisfy the donor center’s regulatory reporting requirements.
    21. Provide kidney pickup times of 10:00 AM (local) or earlier.
    22. Provide kidney delivery times of 18:00 (local) or later.
    23. When arranging a loop swap (no chain starter or bridge donor), all donor surgeries shall be scheduled on the same day except if a red-eye flight is used. The patient receiving the kidney from the red-eye flight will be scheduled for surgery the day following the donor surgeries.
    24. Respond to match offers by the match offer deadline, and:
      1. When a match offer is received, the Member Center shall contact both donor and patient to ensure the pair is ready for surgery.
      2. When a match offer is accepted, the pair must be immediately deactivated in all other exchange programs, including internal programs.
      3. When a match offer is accepted, the patient’s chart must be reviewed for updates and creatinine must be immediately rechecked for predialysis patients.
      4. Any known potential swap risk must be communicated to NKR immediately via email and reiterated on the logistics and kickoff calls.
      5. Consider placing patients who are in NKR swaps on hold for deceased donor transplants once NKR crossmatching commences.
  3. Coordinators
    1. Primary and backup coordinators shall:
      1. Be identified for each Member Center.
      2. Have cell phone numbers and email addresses entered in the NKR system for every coordinator.
      3. Respond the same day (email or phone) during regular business hours.
      4. Be available 24×7 the day before and the day of a swap.
      5. Be available for conference calls (logistic calls, kickoff calls, etc.).
      6. Monitor the GPS beacon for incoming shipped kidneys.
    2. If an exchange coordinator becomes aware of a situation that puts the swap at risk, the coordinator shall immediately send an email to NKR operations with notification of the situation and then immediately call the NKR swap manager.
    3. If a coordinator or center representative is not present on a kickoff call, the NKR will proceed with the swap as scheduled and the center that was not present will assume all liability related to their non-attendance.
  4. Surgeons
    1. Shall ensure surgical capacity is available for NKR swaps for business days including Tuesdays, Wednesdays, Thursdays and Fridays with three weeks advance notice.
    2. The donor surgeon shall call the recipient surgeon within one 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 voicemail will suffice. If there are concerns, a second attempt should be made to reach the recipient surgeon. If the second attempt fails, the recipient center coordinator must be contacted to pass along the information. The surgeons must speak when both are available.
  5. HLA, Crossmatching and Serology Tests
    1. Centers shall accurately enter all patient antigens and avoids.
    2. The NKR provides confirmatory HLA and ABO typing for all donors including subtypes for A and AB donors. If a discrepant HLA, ABO or subtype is reported between the center and NKR, 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. When new pairs are first made exportable, the antibody screenings used to determine the avoids shall be current (within 30 days).
    4. Centers shall conduct antibody screenings every 90 days for sensitized patients and update the avoids appropriately.
    5. If a center reports an unacceptable crossmatch, the lab director shall review the root cause and corrective action plan on the National Lab Director call.
    6. The NKR uses three types of crossmatches:
      1. Exploratory crossmatches are requested by a recipient center prior to a match offer to confirm a donor is compatible with a sensitized recipient.
      2. Screening crossmatches are required once all match offers in a swap are accepted; this crossmatch will be commenced by NKR.
      3. Final crossmatches are requested by the recipient center one to two weeks prior to surgery (cryo preserved samples cannot be used for final crossmatches).
    7. When fresh blood is used, the following crossmatching 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 crossmatch and records the results on the NKR website.
    8. When cryo preserved cells/NUCS are used, the following crossmatching procedures are utilized according to the timeframes in the flowchart below:
      1. NKR lab 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 crossmatch and records the results on the NKR website.
      4. NUCS for exploratory crossmatching shall only be used for crossmatch testing and shall not be used for other purposes such as:
        1. Donor typing
        2. Multiple sera
        3. Multiple platform
        4. Cytotoxicity
        5. Pronase
      5. When using NUCS for a screening crossmatch, additional NUCS may be requested, if needed, to perform additional crossmatch tests.
    9. Virtual crossmatches are acceptable for the screening crossmatch.
      NKR Crossmatch Flowchart
  6. Shipping Kidneys
    1. To reduce the risks related to shipped kidneys using connecting commercial flights, an on-board courier must always be utilized for these connecting flights.
      1. If an issue arises which puts the organ at risk of not reaching the recipient center on time, the NKR may utilize a charter flight. Costs for the transportation of the organ, including charter flights, are the responsibility of the recipient center.
    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 traveling via on-board courier.
      3. NKR-supplied Human Organ stickers affixed to all six 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 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, they will not be paid for the inadequate packaging service. Inadequate service includes, but is not limited to, not responding to an RCCAP request within two business days.
    5. GPS Tracking:
      1. Donor centers will receive a GPS device from NKR approximately three to five business days before donor surgery.
      2. The GPS device must be packed on top of the ice or inserted between the shipping containers.
      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.