For Healthcare Providers

Our multidisciplinary team carefully evaluates each patient for transplant suitability. The following outlines the steps we take from initial referral to decision.

1. Referral package is sent by the primary nephrologist to the Kidney Transplant Program. Please complete the TGLN Kidney Transplant Referral Form and include all required test results with the referral package to facilitate completing the transplant assessment in a timely manner. If the recipient has a living donor, the recipient file needs to be received before any donor work-up will occur.
2. The referring clinician is notified of receipt within five days.
3. Incomplete packages are sent back to the referring clinician for completion. Complete packages are triaged to a nurse coordinator for review.
4. All routine consults and appointments at St. Michael’s are booked within two weeks of receiving the referral.
5. The patient attends a Learn about Transplant class, is provided a “Transplant Passport” and completes tissue typing and an initial cPRA test at St. Michael’s.
6. The patient attends an initial assessment appointment with the transplant nephrologist and a transplant social worker at St. Michael’s.
7. The patient attends all additional routine testing and consults (e.g. CT, anesthesia consult, surgical consult) at St. Michael’s.
8. Additional testing or consultations may be requested by the transplant nephrologist.
9. A final decision on suitability for transplant is issued from the transplant nephrologist.

Our team provides regular updates to patients and referring clinics through mail or email. We will inform you:

1. When we have received the referral
2. If additional test results or reports are required
3. When the patient has seen the transplant nephrologist
4. Each time your patient has an appointment with us
5. When a decision has been made regarding the patient’s suitability for transplant

Iliac Dopplers have traditionally been done at St. Michael’s as part of determining suitability for kidney transplant. In an effort to ease the burden on patients, and based on requests to minimize visits to St. Michael’s, we are asking that you arrange for iliac Dopplers to be done at your hospital. Please include the results with the initial transplant referral package you send to us. We will continue to perform non-contrast CT scans of iliac vessels to assess for vascular calcification at St. Michael’s.

We understand that not all ultrasound departments are familiar with the requirements for pre-transplant iliac Dopplers. Our transplant surgeons are most concerned with the degree of iliac artery stenosis, as this will determine whether the renal allograft will be adequately perfused after the anastomosis with the donor renal artery. As such, we request that your report comment on the:

1. Aorta
2. Common iliac artery and vein
3. External iliac artery and vein
4. Internal iliac artery and vein

For each of these vessels, we request that you assess for the following:

• Diameter
• Presence of aneurysm
• Presence of wall calcification or plaque
• Presence of flow (monophasic, biphasic or triphasic)
• Evidence of stenosis, location and an estimate of how severe (e.g., 50% occluded)

From the time a referral is received, the transplant assessment takes approximately 1-2 years to complete; however this time may vary. To help facilitate the process, it is important that your patient attend all booked appointments.  The specific timeframe depends on the medical complexity of the patient or kidney donor, their availability to attend appointments, and the completeness of the initial referral. For patients who are not yet on dialysis, and have a potential living donor, we try our best to complete the assessment to facilitate transplant pre-emptively before requiring dialysis.

If the recipient is approved for transplant, they may be added to the provincial wait list for a deceased donor kidney. Currently, the wait time in Ontario depends on the patient’s blood type, antibody level, and the availability of organs. Each patient’s position on the wait list is determined by an allocation score, which is calculated from the day they start dialysis:

• Allocation score = 0.1 point per 30 days on dialysis + 4*(cPRA/100)
• As patients gain allocation points, they move up on the wait list.

Those patients who are closer to receiving an organ offer will be triaged appropriately.

For recipients with a living donor, surgery is usually scheduled six to 12 weeks after both the recipient and the donor have been cleared.

An informed patient is key for good health outcomes after transplant. All transplant candidates attend a mandatory Learn about Transplant class as the first step in the work-up process. Patients and family members receive written information throughout the transplant process about different transplant options, what to expect after transplant, how to prepare beforehand, being on the wait list and living donation.

We value our community partnerships and we invite you to come learn with us. Some of the opportunities we offer are:

St. Michael’s Kidney Transplant Symposium: An educational symposium for health professionals. Contact our team for details at [email protected]

Transplant Roadshow: Our team can visit your site to meet with patients and/or staff to provide information about transplant and the chance to ask the team questions about transplant in general. Contact our pre-transplant team to arrange a roadshow at your centre.

Transplant Digest: Informational newsletter written for patients and providers which can be accessed online here.

For patients who have returned to Canada after receiving a kidney transplant who would like to be followed by the post-transplant clinic at St. Michael’s Hospital. A referral should faxed/e-mailed to our clinic from either the patient’s dialysis centre, nephrologist or family doctor. The referral package should include in English:

• the patient’s demographics, transplant date, graft type, country where transplanted
• list of current medications
• OR and hospital discharge summary in English
• recent blood work
• any notes on relevant medical history

Please send referral packages to:

Phone: 416-867-3665 extension 2
Email: [email protected]
Fax: 416-867-3740

Our nursing team will review the information and contact the patient directly for any upcoming appointments.