Member Center Guidelines

The following guidelines are for all NKR Member Centers.

Living Donor Evaluation

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 OPTN standards will be used for donor evaluations. Donor evaluations must be completed before a donor can be activated in the NKR. The donor center evaluation policies should be followed by the donor center and not be directed by the recipient center since the donor center is responsible for donor care. The receiving center may ask for additional testing to clarify issues related to the quality of the kidney or to ensure there is minimal risk of infectious disease transmission. Requests for additional donor testing should be made immediately upon crossmatch and donor record review commencement in order to avoid swap failures.

  1. Member Centers are encouraged to use the NKR donor chart format when uploading a donor chart.
  2. Basic Evaluation:
    1. Complete history and physical
    2. Height, weight, BMI
    3. Blood pressure at two different settings on different days
    4. General laboratory tests 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
    8. Donor workups must be repeated in their entirety, every 12 months, except for CT angio, unless the first CT angio was abnormal.
  3. Kidney Evaluation:
    1. Urinalysis with microscopy
    2. Urine culture if indicated
    3. 24-hour urine or Cystatin-C for albumin excretion and creatinine clearance
    4. Anatomic testing for anatomy definition
    5. If a donor GFR reading is below 85, the center will perform a nuclear medical GFR test to confirm the donor’s GFR.
    6. The minimum acceptable GFR for donors age 60 and under is 80. The minimum acceptable GFR for donors over age 60 is 75.
    7. If there is > 10% difference in donor kidney size (between the two kidneys) then the smaller kidney will be offered for donation.
    8. Spot urine albumin: creatinine ratio measurements may be used instead of 24-hour proteinuria at centers that use nuclear medicine GFR measurement. The acceptable range for urine albumin: creatinine ratio is less than 30 mg/Gm.
  4. Tuberculosis screening:
    1. Chest X-ray (CXR)
    2. Criteria for high risk donors: (based on history and physical):
      1. Birth or residence in a TB endemic country
      2. Close contacts of individuals with TB (household or family members)
      3. Donors who work or have resided in homeless shelters, correctional facilities, nursing homes, or hospitals
      4. History of IV drug use
      5. Evidence of granulomas or healed TB on CXR
    3. For donors meeting the criteria for high risk, we recommend interferon-gamma release assays (IGRAs) or tuberculin skin test (TST).
    4. Recipient center may choose to have additional testing performed upon match offer acceptance.
  5. Infectious disease screening:
    1. CMV
    2. EBV
    3. HIV 1, 2
    4. HBsAg, HBcAB, HBsAB
    5. HCV
    6. RPR
    7. Depending upon time of year and location-associated risk:
      1. Strongyloides
      2. Trypanosoma cruzi
      3. West Nile virus
      4. Toxoplasmosis
  6. Suggested evaluation for donors at risk for metabolic syndrome or diabetes:
    1. Uric acid
    2. HbA1C
    3. Glucose tolerance testing
  7. Stone Disease:
    1. If multiple stones or nephrocalcinosis are not evident on CT, an asymptomatic potential donor with history of a single stone may be suitable for kidney donation if they have:
      1. No hypercalciuria, hyperuricemia or metabolic acidosis
      2. No cystinuria or hyperoxaluria
      3. No urinary tract infection
    2. An asymptomatic potential donor with a current single stone may be suitable if:
      1. The donor meets the criteria shown previously for single stone formers
      2. The current stone is less than 1.5 cm in size, or potentially removable during the transplant
    3. Stone formers who should not donate are those with:
      1. Nephrocalcinosis on X-ray or bilateral stone disease
      2. Stone types with high recurrence rates, and are difficult to prevent

Standard Voucher Donation

To ensure that the NKR can find the best-matched recipient for every kidney donated through the Standard Voucher Program, the following guidelines are in effect for all Member Centers, and must be confirmed prior to activation in the NKR system:

  • Donation start date must be three weeks from activation
  • Donation end date must be at least three weeks from start date

Post Donation Follow-Up and Donor Complications

A post-donation follow-up should follow the policy described in CMS Pub. 100-02, Chapter 11, section 140.9, including:

  1. Donors should be made aware of their donation options.
  2. It is the responsibility of the center to educate the donors. Centers should fully explain the donation process to the donor and let them know what to expect, before, during and after surgery.
  3. Centers should ensure that donors can get appropriate time off from work.
  4. Centers should determine the donor’s availability for surgery and accurately enter it into the NKR system.
  5. Centers should ensure the donor is updated on a timely basis regarding where they are in the workup process, results of all medical tests and when they are activated in the NKR program.
  6. The center should inform the donor of the Donor Shield support and protections.