ordinator 11 The procedures of transplantation are truly inter-disciplinary, using facilities and expertise from other departments, such as anaesthesiology, operation rooms, intensive care unit, nephrology outpatient clinic, dialysis unit, ultrasound unit, cardiovascular interventional laboratory, clinical chemistry, clinical immunology, infectious diseases and histopathology. IV. Duties and Responsibilities of the Transplant Team Members The Director of the transplant centre is responsible for all activities of the centre. He/she is assisted by the Vice Directors and the other members of the Board. There may be a meeting of the Board, chaired by the Director or one of the Vice Directors, every day after the ward round, with at least the transplant nephrologist, the transplant surgeon, the transplant co-ordinator, the head nurse and a young nephrology specialist, all of whom also attended the ward-round. This meeting is to further discuss clinical problems with current patients. Once every week, there should be a Board meeting with the presence of all board members. The agenda of this meeting should include current patient progress, general affairs of the transplant centre, and presentation and acceptance of future living donor / renal recipient couples. The meeting could also include a journal club (presentation and discussion of novel international clinical studies in the field of transplantation). The transplant nephrologist (Vice Director) is in principle responsible for the work up (preparatory examinations) of the living donor and the recipient. In practice, in order to avoid conflict of interest in assessment of donor and recipient it is preferable to have two nephrologists for each couple, one for the donor and one for the recipient. The transplant nephrologist is the main responsible senior physician for the patients admitted to the transplant ward. He is also responsible for the long-term follow-up of the donor and the recipient. The transplant surgeon. There should preferably be two, one responsible for the living donor operation and the other responsible for the recipient operation. The transplant surgeon who is also Vice Director will take part in all ward-rounds post-operatively and in the Board meetings. The cardiologist will be responsible for the operative risk assessment of both the living donor and the recipient. This includes evaluation of the examination results of ECG, echocardiography, myocardial scintigraphy, coronary angiography, and CT-angiography. Practical Protocols for Living Donor Kidney Transplantation 12 The head of the transplant laboratories will be responsible for the analyses and evaluation of results of HLA tissue typing, crossmatching, clinical chemistry tests, CMV, BK virus and hepatitis virus tests, and tacrolimus concentration measurements. The transplant co-ordinator will be responsible for the information and educational activities; contacting the potential recipient and donor during work up; contacting the insurance company and informing the patient about costs; and scheduling the patient operation after acceptance by the Board, making sure there are surgeons and operating rooms and bed space available, and possibly pre-operative dialysis facilities. Following the operation, the transplant co-ordinator helps educate the patient in medication adherence and other behaviour important for the success of the transplantation. They also co-ordinate the schedule of initial follow-up after transplantation. Finally, the coordinator is responsible for entering data into the clinical database. The head nurse of the transplant ward is responsible for the transplant nursing staff, their availability and competence, and making sure that all protocols and nursing procedures are followed as intended. She/He should be present at ward rounds and Board meetings. She/He should report to the Board if there is any need for an update of procedures or further training of her/his nursing staff. V. External Assistance of Special Importance The ultrasound department will be responsible for ultrasound investigations of the recipient. The fi rst examination should routinely be performed within 24 hours after transplantation. If the graft is nonfunctioning, it should be done immediately if there is to be any chance of saving the graft that has a compromised blood supply, to ensure that there is suffi cient circulation to the graft. Ultrasound will also be used for guidance of graft biopsy in case of suspected acute rejection. In cases of out fl ow obstruction of urine, a percutaneous nephrostomy should be placed into the kidney pelvis. If the obstruction has not spontaneously disappeared after a few days, balloon dilatation and insertion of a double-J catheter placed from the pelvis to the bladder should be considered. Examination reports should be given at the ultrasound department in the presence of the transplant team. The histopathology department will be responsible for the preparation and evaluation of the kidney graft biopsy in cases of suspected acute rejection. Examination reports should be given at the histopathology department in the presence of the transplant team. A legal advisor should be employed to assist the Board in legal matters and ensure that national legislation is adhered to, most 13 importantly concerning the family relationship between the living donor and the recipient. Also, advice may be