Patients with or nearing end stage renal disease may be considered for renal transplantation. Carolinas Medical Center does not have absolute age criteria; instead, all patients are reviewed on an individual basis to provide non-discriminatory consideration. 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 may be mailed to:
CMC Transplant Center
P.O. Box 32861, Charlotte, NC 28232

Or faxed to 704-446-4876.

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

Evaluation Process

The intake team reviews all referrals and contacts your patient. 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, which includes:

  • Education sessions
  • Psychiatric/social evaluation
  • 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

The following tests are the responsibility of the patient:

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

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 follow-up
  • Patient's refusal

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
  • Must have evidence of secondary microvascular complications

Contraindications for combined kidney-pancreas transplantation:

  • Untreated or active malignancy
  • Chronic or active infection
  • Untreated 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

Contact a Transplant Specialty

704-355-6649 or 800-562-5752

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