What are the guidelines for living donor kidney transplantation when the donor surgery is performed at a remote center and the kidney is shipped to the recipient's center?

Remote Donor Surgery with Kidney Shipment

The psychosocial evaluation and final acceptance decision must occur at the center where the donor surgery will take place, not at the recipient's center. 1, 2 This means if the donor surgery is performed at a remote center with the kidney shipped to the recipient's center, the donor evaluation and acceptance process should be conducted at the donor's surgical center.

Key Operational Requirements

Evaluation Location

• A detailed on-site psychosocial evaluation is mandatory at the transplant center where donor surgery will be performed (the remote center in this scenario). 2
• The evaluation must be conducted by an independent donor team entirely separate from the transplant candidate's team. 2
• This requirement exists with only one exception: paired donation programs may conduct evaluation at the donor's local center before entering the matching system. 1, 2

Timing and Coordination

• The psychosocial evaluation should occur early during the complete medical evaluation to avoid unnecessary invasive procedures if psychosocial contraindications emerge. 2
• A mandatory "cooling off" period of at least 2 weeks is required after the Phase II evaluation to ensure the donation decision has been adequately considered without pressure. 2
• Critical coordination between the remote surgical site and the recipient's transplant center is essential to ensure proper timing and avoid complications. 2

Financial and Follow-Up Considerations

Cost Coverage

• The transplant program must ensure that donors do not incur out-of-pocket costs for recommended follow-up care. 1
• This is particularly important when the donor resides at a distance from either center, as repeated returns for follow-up may create financial burden. 1

Post-Donation Care Planning

• Whether follow-up care occurs at the donor's surgical center (remote site) or the recipient's transplant center should be determined through mutual agreement reached prior to donation. 1
• If local care at the donor's site is pursued, the recipient's transplant program must consult with the local provider to monitor the donor's status. 1
• The donor's ability to cover financial costs associated with repeated returns to either center must be discussed and resolved before proceeding. 1

Common Pitfalls to Avoid

• Do not conduct the donor evaluation at the recipient's center when surgery will occur remotely—this violates established guidelines. 1, 2
• Do not proceed without establishing clear follow-up arrangements that account for the geographic separation between surgical and recipient centers. 1
• Do not allow financial barriers to prevent appropriate donor follow-up—the program must ensure these costs are covered. 1

Mandatory Annual Monitoring Requirements

Regardless of where surgery occurs, all living donors require annual monitoring including: 3

• Blood pressure and BMI measurement
• Serum creatinine with GFR estimation
• Albuminuria measurement
• Lifestyle counseling and psychosocial well-being assessment
• Avoidance of nephrotoxic medications