Member Center Requirements: General

  1. General
    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 NKR high resolution tissue typing results uploaded into the NKR system for all donors and recipients.
    7. Immediately request an exploratory crossmatch if there is a reasonable chance of an unacceptable crossmatch.
    8. Ensure swap participants are ready to go to surgery when activated in the NKR.
    9. Not contact another center’s donor, patient or lab for any purpose.
    10. Provide a root cause and corrective action plan to the NKR within one business day of the request.
    11. 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.
    12. Utilize the NKR’s Streamlined Serology Service (this excludes internal one-ways and matches offered less than 14 days before the surgery date).
    13. 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.
    14. 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.
    15. 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.
    16. Register the donor and obtain a UNOS donor ID number.
    17. Have laparoscopic donor surgical capability.
    18. 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.
    19. 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.
    20. Provide kidney pickup times of 10:00 AM (local) or earlier.
    21. Provide kidney delivery times of 18:00 (local) or later.
    22. 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.
    23. 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.
  2. 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.
  3. 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.
  4. 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 for patients with a cPRA >99% prior to a match offer to confirm a donor is compatible.
      2. Virtual crossmatches are recommended during the preselect phase. These crossmatches become required during the donor record review phase of a swap.
      3. Final crossmatches are requested by the recipient center and are due no later than six business days before the scheduled transplant date.