Transplant Referral Guide

Facility-Specific Referral Criteria

Section 494.80(a)(10) of the revised Conditions for Coverage for ESRD Facilities, effective October 14, 2008, sets forth requirements for patient assessment with regard to transplantation referral:

"Evaluation of suitability for a transplantation referral, based on criteria developed by the prospective transplantation center and its surgeon(s). If the patient is not suitable for transplantation referral, the basis for nonreferral must be documented in the patient’s medical record."

Interpretive Guidance states that regulations for transplant programs require written selection criteria to be developed, and provided upon request, to patients and dialysis facilities. Selection criteria vary among transplant centers; if the dialysis facility refers patients to multiple transplant centers, the dialysis facility should have the selection criteria for each center on file and available to patients.
 

Transplant Referral Guidance (For All Patients in a Maintenance Dialysis Program)

Evaluate and Classify the Patient

The Medical Record Will Indicate That:

• The patient has been evaluated of suitability for a transplant referral, based on individual transplant center criteria, by the interdisciplinary care team including, but not limited to, a nephrologist, a nurse, a social worker, a dietitian and the patient or patient designee
   
• The patient has been classified as a suitable or unsuitable candidate for transplantation.
   
• This initial assessment must be completed within 30 calendar days of admission to the facility or within the first 13 outpatient treatments within the facility.
   
• The ESRD Conditions for Coverage mandate a comprehensive reassessment of each patient annually (at minimum) with the revision of the Plan of Care. Both the patient assessment and Plan of Care should include reevaluation of treatment modality and transplant status.

Inform Patient & Document Decision

The Medical Record Will Indicate That:

• Suitable patients were presented the option of referral to a transplant center for evaluation, received transplant center contact information, and received information on deceased donor and living donor transplant.

Document Transplant Status

If the patient IS a transplant referral candidate, the medical record will indicate:

• Patient's decision to accept of decline the transplant referral
• Plans for pursuing transplantation, if the patient accepts the referral
• Patient refused the transplant option after further consideration  

If the patient is NOT a referral candidate, the medical record will indicate:

• Reasons for the non-referral as a transplant candidate

Track Transplant Referrals

• Monitor the status of each patient on the transplant wait list
• Communicate with the transplant center regarding patient status at least yearly and whenever there is a change in status

Medicare and Medicaid Programs; Conditions for Coverage for End-Stage Renal Disease Facilities; Final Rule. Federal Register 73:73 (15 April 2008) p. 20479.