Carolinas HealthCare System
Transplant
Transplant

Kidney and Pancreas Referrals

Contact Information

How to Refer a Patient

Patients may be referred to the Transplant Center for consideration by their nephrologists.

For more information on the referral process, contact the Intake office at 704-355-6649 or print the referral form and fax required information to
704-355-7616.

For physicians

When to refer a patient

The length of time a patient is on dialysis is a significant risk factor for transplant outcomes, so referrals should be made as soon as possible. Early referral will expedite evaluation, allow for any living donors to complete evaluation, and possibly pre-empt the need for dialysis. A patient may be listed for transplantation once approved by the transplant team.

How to refer a patient

Patients may be referred to The Transplant Center for consideration by their nephrologist.

Please print and complete the referral form. Incomplete referral will delay your patient's case.

The following documents must be included with the referral:

  • Legible copy of BACK and FRONT of all insurance and prescriptions cards
  • Medicare Form 2728 (if on dialysis)
  • Patient's signature in 2 places:
    • Page 1 HIPAA Privacy Act
    • Page 3 Authorization for Release of Health Information
  • History and Physical (within 1 year)
  • Current List of Medications
  • Current Labs results
  • PPD results (within 1 year)
  • Nutritional Assessment
  • Psych/Social Assessment

The referral can be mailed to:
CMC Transplant Center
P.O. Box 32861, Charlotte, NC 28232

Or faxed to 704-355-7616. For additional information on the referral process, contact the Kidney Intake team at 704-355-6649 or 800-562-5752.

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Evaluation process

After a referral is received, the Intake team will review it and contact your patient to begin the process. The patient's information also is forwarded to a transplant financial coordinator to verify transplant coverage. Once authorization for the evaluation is obtained from the insurance company, the patient is scheduled for an outpatient evaluation.

The evaluation process includes but is not limited to:

  • Group Teaching session (2 hours) – all patients are required to attend
  • Education with a certified transplant coordinator (a one-on-one teaching session)
  • Psych/social evaluation with a Master's prepared social worker
  • Transplant nephrology evaluation
  • Transplant surgeon evaluation
  • Transplant financial coordinator evaluation and counseling
  • Chest X-ray
  • Electrocardiogram
  • Laboratory work, including serologies and tissue typing (HLA)
  • Other testing as indicated by a patient's condition (for example, diabetics may require cardiac testing)

The following tests are the responsibility of the patient:

  • Mammogram within 12 months for females over the age of 40
  • Pap smear within 12 months for females over the age of 18
  • Colonoscopy for patients over the age of 50

At the completion of the evaluation, each patient’s case is discussed at a multidisciplinary transplant conference to determine if a patient is an appropriate candidate for transplantation. Prior authorization for transplantation is then requested from the insurance carrier. Once obtained, any potential living donor may complete their evaluation. If there are no living donors, the patient then may be placed on the United Network for Organ Sharing national waiting list.

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Who can be evaluated

Kidney only referrals:

Patients with or nearing end stage renal disease may be considered for renal transplantation. Carolinas Medical Center does not have absolute age criteria. All patients’ cases are reviewed on an individual basis to provide fair and non-discriminatory consideration.

Contraindications to renal transplant:

  • Untreated and/or active malignancy
  • Chronic and/or active infection
  • Untreated and/or active cardiac ischemia
  • Advanced heart failure (unless candidate for combined heart/kidney transplant)
  • Advanced liver disease (unless candidate for combined liver/kidney transplant)
  • Advanced cerebrovascular or neuro-degenerative disease
  • Severe chronic lung disease
  • Active collagen vascular disease
  • Uncorrected urologic disease
  • Morbid obesity
  • Severe malnutrition
  • Ongoing non-adherence to medication and treatment regime
  • Active substance abuse, including smoking
  • Marked deconditioning
  • Severe peripheral vascular disease
  • Social instability, in particular poor family support and limited resources to maintain ongoing followup
  • Patient's refusal

Kidney-pancreas referrals:

Patients with or nearing end stage renal disease secondary to type 1 diabetes mellitus may be considered for kidney-pancreas transplantation. All patients’ cases are reviewed on an individual basis to provide fair and non-discriminatory consideration. There is no absolute age criterion.

Patients with type 2 diabetes mellitus will be considered for kidney-pancreas transplantation with the following guidelines:

  • BMI < 27
  • < 1.0 units insulin/kg/24 hours
  • Must be a candidate for Steroid Avoidance Protocol to prevent exacerbation of insulin resistance.
  • Must have evidence of secondary microvascular complications

Contraindications for combined kidney-pancreas transplantation:

  • Untreated and/or active malignancy
  • Chronic and/or active infection
  • Untreated and/or active cardiac ischemia
  • Advanced heart failure
  • Advanced liver disease
  • Advanced cerebrovascular or neuro-degenerative disease
  • Severe chronic lung disease
  • Active collagen vascular disease
  • Uncorrected urologic disease
  • Excessive obesity
  • Severe malnutrition
  • Ongoing non-adherence to medications or treatment regime
  • Active substance abuse, including smoking
  • Marked deconditioning
  • Social instability, in particular poor family support and limited resources to maintain ongoing follow up
  • Patient’s lack of interest or refusal
  • Patient's refusal to accept a blood transfusion in life threatening situations

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Wait list maintenance

When patients are on the waiting list, they will be scheduled for a re-evaluation at the Transplant Center on an annual basis. Patients and dialysis units are asked to keep the Transplant Center updated with any changes in patients’ condition that may affect candidacy, as well as with changes in address, phone #, dialysis center location, and health insurance.

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How organs are allocated

Organ allocation guidelines are based on United Network for Organ Sharing and Organ Procurement Transplant Network policies that include medical criteria, as well as equitable utilization of organs. The current kidney allocation policy considers characteristics of the deceased donor and the transplant candidate in allocating kidneys equally, efficiently and effectively. A combination of factors working together determines which patient receives which organ. These factors include tissue match between donor and candidate, blood type, blood antibody levels, length of time spent on the waiting list, age, body size of both donor and candidate, and geographic factors.

When a kidney becomes available, the referring physician will be notified prior to calling the patient.

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Other resources
  • For more information on organ donation and allocation, please visit www.unos.org.
  • For more information regarding center specific data and statistics, please visit www.ustransplant.org.
  • For questions about the Kidney/Pancreas Transplant Program, please call 704-355-6649 or 800-562-5752.

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