Kidney Transplant Program

Health-care Providers

Please use the below form to refer your patients.

TGLN Kidney Transplant Referral Form

Please include all required test results with the referral package to facilitate completing the transplant assessment in a timely manner.

The following information describes the patient services and resources available to kidney transplant candidates at St. Michael’s, our transplant evaluation process and timeline, and our communication standard.

Frequently asked questions

What transplant options and services are available for patients at St. Michael’s?

We offer a variety of options for adult chronic kidney disease (CKD) patients who are interested in pursuing kidney transplant.

Deceased donor kidney transplant options:

• The provincial waiting list, managed by Trillium Gift of Life Network (TGLN)
• The Highly Sensitized Patient (HSP) Program, a national registry for patients with difficult-to-match antibody levels (cPRA ≥95%)
• The extended criteria donor (ECD) list, which reduces the waiting time for eligible older patients

Living donor kidney transplant options:

• Direct donation between compatible pairs, including donors from out-of-country
• Direct donation between blood-group incompatible donor-recipient pairs by desensitization using Glycosorb^® technology (the first in North America)
• The Kidney Paired Donation (KPD) Program, which works to match donors and recipients across Canada
• The List Exchange Program

Our multidisciplinary team provides a comprehensive suite of services for transplant candidates, recipients and living donors, including:

• Transplant candidate assessment
• Living donor candidate assessment, including out-of-country donors, when feasible
• Longitudinal multidisciplinary post-transplant follow-up care
• Patient health information website, print material, and group and individual in-person classes
• Opportunities to participate in clinical research trials
• Opportunities for patients and families to provide input via the Patient and Family Advisory Council

What are the steps involved in the transplant evaluation process?

We carefully evaluate 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.
2. The referring clinician is notified of receipt within five days.
   • Incomplete packages are sent back to the referring clinician for completion.
   • Complete packages are triaged to a transplant RN coordinator for review.
3. All routine consults and appointments at St. Michael’s are booked within two weeks of receiving the referral .
4. 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.
5. The patient attends an initial assessment appointment with the transplant nephrologist and a transplant social worker at St. Michael’s.
6. The patient attends all additional routine testing and consults (e.g., CT, anesthesia consult, surgical consult) at St. Michael’s.
7. Additional testing or consultations may be required from the referring clinician.
8. A final decision is issued from the transplant nephrologist.

What should be included in the iliac Doppler report?

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).

How do I find out the status of my patient’s transplant workup?

We will provide regular updates to let you know the status of each patient’s transplant workup. 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

We also maintain regular contact with patients directly through mail or email to provide them the same updates.

In order to provide timely updates, it is important that we have the most current referral contact details. If a patient changes care teams or there are staff changes, please inform us as early as possible by email.

• For patients without a living donor: Meriam.Jayoma@unityhealth.to
• For patients with a potential living donor: Andreea.Gavrus@unityhealth.to

How long will my patient wait for a kidney?

From the time a referral is received, the transplant assessment takes three to nine months for recipients with a living donor and six to 12 months for recipients without a living donor. The specific timeframe depends on the medical complexity of the patient or kidney donor, his or her availability to attend appointments, and the completeness of the initial referral. For patients with a living donor not yet on dialysis, we try our best to complete the assessment to facilitate transplant pre-emptively before requiring dialysis.

If the recipient is approved for transplant, he or she may be added to the provincial wait list for a deceased donor kidney. Currently, the wait time in Ontario may be up to five to nine years, depending on the patient’s blood type and antibody level and the availability of organs. Each patient’s position on the wait list is determined by an allocation score, which is calculated as:

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.

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

What can I do to prepare my patient for kidney transplant?

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. All of our patient education material is posted on our Kidney Education Resources page. We welcome you to use these resources to educate patients and their potential kidney donors.

If you’d like to increase your own transplant knowledge to better educate and inform patients, we encourage you to attend our next educational symposium for nephrology nurses and allied health professionals. Contact our team for details.

How long does a kidney transplant last?

Our graft survival rates are comparable to or exceed those seen in transplant centres across North America.