Transplantation

Candidates for renal transplantation undergo an extensive evaluation to identify important medical and psychosocial factors that may have an adverse effect on outcome.4 A thorough evaluation will identify potential pertinent health, social, and financial impediments to a successful transplant that can be solved prior to the procedure. Virtually all transplant programs have a formal committee that meets regularly to discuss the results of evaluation and select suitable candidates for immediate living donor transplantation, or to place on the cadaveric waiting

Table 6.1. UNOS cadaver kidney allocation system

1. Blood type O kidneys transplanted only into blood type O recipients

2. Sharing of zero antigen mismatched kidneys

3. Sharing of zero antigen mismatched kidneys to combined K-P candidate

4. Geographic sequence of cadaveric kidney allocation

A. Local allocation

B. Regional allocation

C. National allocation

5. Double kidney allocation: kidneys offered singly unless the donor meets at least two of the following conditions:

A. Donor age >60 years

B. Estimated Cr Cl<65 ml/min

D. Adverse donor kidney histology (moderate to severe glomerulosclerosis)

6. Expanded criteria donor kidney allocation. Expanded criteria donors are defined by an "X" in the matrix shown below indicating increased relative risk of graft failure based upon the following factors: age, creatinine, CVA, and hypertension.

Donor Condition

Age 50 - 59 Age > 60

CVA + HTN + Creat > 1.5

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