examination results. Final work up and decisions ● Donor visits the transplant surgeon and receives information about the surgical procedures. ● The case is presented to the Board of the transplant centre for decision. ● The timing of the donation and transplantation is decided. ● Cross match no. 2 is performed two weeks before the day of operation. Practical Protocols for Living Donor Kidney Transplantation 20 Check List for Kidney Living Donation – page 1 Primary Work Up Step 1 □ Written information □ Blood group Step 2 □ Visit to nephrologist Medical history (incl heredity, previous operations, smoking) Physical examination Height and weight (BMI) List of medication Allergy □ ECG □ Clinical chemistry (attached list) □ GFR measurement □ Oral Glucose Tolerance Test □ Echocardiography including kidney and renal artery ultrasound □ Visit to the social worker (no. 1) Step 3 □ Responsible nephrologist summarises the test results □ Inform the potential donor □ Inform the recipient’s nephrologist Donor Name: Date of birth: Address: Telephone: Mobile: Recipient Name: Date of birth: 21 Check List for Kidney Living Donation – page 2 Secondary Work Up Step 4 □ Chest X-ray □ Myocardial scintigraphy (if the donor is >50 years old) □ CT angiography □ Additional investigations Step 5 □ Visit to the responsible nephrologist, summary of test results □ Visit to the social worker (no. 2) □ Referral to the transplant surgeon, including: ●Summary of the medical history ●Clinical chemistry results ●Social worker’s report ●Blood group ●Cross match ●Tissue type ●ECG ●Myocardial scintigraphy (if applicable) ●Chest X-ray ●GFR There is no contraindication against kidney donation: Place and no. 2 is performed two weeks before the operation Practical Protocols for Living Donor Kidney Transplantation 22 Blood Results Haemoglobin Leucocytes Platelets Plasma CRP Bilirubin ALP GT AST ALT Albumin PK APT-time Creatinine Sodium Potassium Calcium Phosphate Base excess Urate Fasting blood sugar HBA1c Triglycerides HDL-cholesterol LDL-cholesterol Separate reports on the following tests are attached to the referral documents Plasma electrophoresis Urine Electrophoresis Tissue type Cross match; serology and FACS Serology for HbsAg, anti-HBs, antiHBc, HCV, HIV Serology for CMV, herpes, varicella, Epstein-Barr Urine sedimentation Urine culture Urine dip test Check List for Kidney Living Donation – page 3 Clinical chemistry of potential kidney living donor Evaluation of laboratory fi for Living Donor Kidney Transplantation 24 4. Protocols for the Doctor: Admission of the Recipient Before Transplantation □ Write the medical report with focus on the most recent ●Methylprednisolone 500 mg IV is given at the start of the operation. ●Prednisolone 100 mg IV is given 8 hours after the start of the operation. □ Order thrombosis prophylaxis using low molecular weight heparin, enoxaparin sodium 20 mg daily, starting before the operation. □ Order antibiotic prophylaxis; e.g. cefuroxim 1.5g in a single pre-operative dose. In cases of allergy to penicillin, clindamycin may be given. □ Order co-medication; iron and erythropoietin can be withdrawn, but not vitamins (vitamin D or B12). □ Order the operation and have the patient report to the anaesthetist. □ Wait for and check the pre-operative blood sample and chest X-ray results. □ Decide which side The transplant surgeon should decide and mark the left or right groin of the patient for transplantation. □ Cross match Final check that the cross match was negative. 25 5. Protocols for the Nurse: Admission of the Recipient Before Transplantation □ Find the patient’s medical records. □ Find previously prepared forms, or prepare a collection of referral forms for laboratory and X-ray. □ Blood samples: 1．Urgent blood tests: plasma (P)-sodium, P-potassium, P-creatinine, P-albumin, P-calcium, P-CRP, blood (B)- haemoglobin, B-leucocytes, B-thrombocytes, B-erythrocyte volume fraction, P-glucose, P-TCO2, P-PK, P-APTT. 2．Routine blood tests: P-bilirubin, P-AST, P-ALT, P-GT, P-pancreas amylase, P-urate, B-differential count, P-phosphate, P-magnesium, B-MCHC, B-MCV. 3．Virus tests: HBsAG, anti-HBV, anti-HBC, anti-HIV, anti-CMV, anti-EBV, anti-HSV, anti-VZV. 4．Blood group: check previous blood group test and make sure it is still valid. 5．Cross match: take blood samples for making the cross match against the donor. □ Blood transfusion: order two units of blood, fi ltered to avoid CMV, to be prepared if needed. □ Weight and height. □ Chest X-ray and ECG. □ Preparations for the operating theatre. Shower, shaving, clothing. □ Immunosuppression: give medication according to the doctor’s orders. □ Medical record: make sure that the medical records are being updated after the patient has been seen by the doctor. □ CAPD catheter: patients having peritoneal dialysis should empty the abdomen of fl uids before going to the operating theatre. Fostering Effective Communication Skills for Addressing Serious Illness Chronic kidney disease (CKD) and end-stage renal disease (ESRD) frequently occur in conjunction with serious conditions such as cancer, cerebrovascular disease, diabetes, heart disease, and liver failure. Although dialysis can improve CKD symptoms such as uremia and fluid overload, the increasing age of patients initiating renal replacement therapy means that many also have comorbidities such as