needed concerning possible insurance matters and patient complaints. VI. The Patient’s Journey from Dialysis to Transplantation 1. The recipient and his or her living donor will be examined during the work-up phase by the nephrologists at the out-patient clinic. 2. The patients will visit the surgeons who are going to be responsible for the donor operation and the transplantation, respectively. 3. The clinical data of the donor and recipient are presented to the Board of the transplant centre. The Board decides to accept or reject the patients for donation and transplantation. If accepted, the transplant co-ordinator schedules the admission and operations. 4. Patients are admitted to the transplant ward and seen preoperatively by the nephrologists in charge, the operating surgeons and the anaesthetist. 5. Day of operation. The donor operation is performed by Dr no.1 and the recipient operation is performed by Dr no. 2. It is suggested that Dr no. 3 will assist during the donor operation until the kidney is retrieved. Then he takes the kidney to the operating room of the recipient, where he will assist Dr no. 2 who has already started the recipient operation. 6. Post-operatively, when the recipient is extubated, awake and stable, the fi rst 24 hours are spent in an intensive care bed of the transplant ward, then one or two weeks are spent in a normal bed. The donor should be discharged at one week. 7. Follow-up is performed in the out-patient clinic of the nephrology department. The donor should be contacted by telephone by the transplant co-ordinator one week after discharge, and should then visit the out-patient clinic at one month, six months and one year. The recipient should be seen three times per week initially, then twice a week, then once a week, then once in two weeks. At four months one visit every month is adequate if all is well. VII. Clinical Follow-up Database A database for clinical follow up after kidney transplantation should be established at the transplant centre. This will enable the centre to report short- and long-term transplant outcome taking into consideration numerous clinical parameters. The results may be compared to international standards and may also be reported to the hospital or city authorities and the Ministry of Health. Practical Protocols for Living Donor Kidney Transplantation 14 VIII. Education and Further Training of Doctors and Nurses During the start-up phase of transplant activities at the transplant centre it is important that all personnel, including both doctors and nurses, are well aware of all details of the clinical protocols. Therefore, educational activities should be organised concerning various issues and for various sections of the staff. Courses and seminars of a few hours to a day in duration should be given. Some of these activities should be repeated when needed, especially for incoming nursing staff. IX. Internet Publication of Protocols and Transplant Results The transplant centre may have an internet web page. Here, all protocols in this book with local applications may be published so that they are easily accessible for all staff of the hospital. Any updates will be easy to make. The Board of the transplant centre should be responsible for updating the protocols of this book at least once every year. Also, with time, transplant results including graft and patient survival, and complication rates may be published on the transplant centre web page. Making this combination of the methods, procedures, protocols and clinical results available will create total transparency, and the objective of the transplant centre – to perform living donor kidney transplantation to high international standards – may be assessed. 15 1. Kidney Recipient Work Up Referral to the Transplant Centre Name of patient: Name of nephrologist: A summary of the medical history of the patient should include the following information: Social conditions: Profession, living standards, family, smoking status. Previous medical history: Any abdominal operations, urological and genital diseases, ulcer disease, malignancy, infections. Present medical history: Original kidney disease, dialysis history, access history, remaining diuresis mL per day, problems urinating, previous transplantation. Risk assessment: Specific problems associated with transplantation, especially cardiovascular symptoms, tests and evaluation. Allergy Contagious disease: Tuberculosis, hepatitis B, hepatitis C, HIV Physical examination: Height, weight, blood pressure. Evaluation: The referring nephrologist’s opinion about the patient as a candidate for transplantation. Possibilities for a living donor; how far has the living donor work up proceeded; name of the potential donor and relationship to the patient. Patients who are scheduled for renal transplantation shall receive (if they need a blood transfusion) blood which is fi ltered to reduce leucocytes in order to avoid sensitisation. The following work up of the recipient should be done before referral and copies of all examinations should be attached to the referral documents: □ Blood group □ Tissue typing, HLA-A,B,DR □ HLA-antibodies, PRA □ APC resistance □ Clinical chemistry list □ Lipids, Ca, PTH Viral serology □ HIV □ HBsAg, HepBcAb, HepBsAb □ Hepatitis C □ Hepatitis C PCR, if HCV positive □ CMV □ Varicella Zoster □ Herpes Simplex □ Epstein-Barr □ Syphilis □ Electro