SAN DIEGO — While the executive order signed by president Donald J. Trump last July to set new goals for increasing transplant rates has garnered most of the attention in the kidney community, CMS has been working behind the scenes on new interpretive guidelines for surveyors that will affect transplant center operations, including staff education and processes prior to the transplant, Gail DeWald, BS, RN, CNN, noted in a talk here.
Advancing American Kidney Health, which calls for doubling the number of kidneys available for donation by 2030, will require new approaches to make donation more attractive to U.S. residents and ask transplant centers to relook at ways to be more efficient with organs received for donation.
“Hospital transplant programs are judged just like dialysis centers,” DeWald said. “There is a [quality incentive program] QIP and now they are talking about changes in the regulations ... it’s like being caught between a rock and a hard place” for transplant centers to adopt to the new requirements, she said.
Advancing American Kidney Health is supporting an extension of national Family Leave Act provisions to those who donate an organ, DeWald said.
“We know that if you donate a kidney and have a job, [employers] don’t have to pay you that 6 weeks of recovery time, so that is a disincentive to give a kidney. If that could be resolved, we may have more donations,” she said.
There is also an effort in Congress to make lifetime immunosuppressive drugs available to kidney transplant patients, DeWald said. That benefit ends after 3 years if a person receives a transplant and is younger than 65 years old.
The interpretive guidelines released by CMS in early summer, while still proposed, are now being used by state surveyors to prepare transplant centers for the upcoming changes. These would require transplant centers to document the details of the planned transplant before heading to the OR.
“A lot of these changes are based on timelines; they will have to document the plans for the transplant surgery onsite, after the donor has arrived, but before anesthesia. Verification of the donor must be done immediately before they go into surgery,” DeWalt said.
According to the proposed guidelines, transplant also begins when the potential transplant candidate is identified.
“That could be years,” DeWalt noted, based on the need for compatibility and psychological testing before an organ donor is accepted. The discharge period begins after the surgery — a shorter period.
Also, during discharge, financial information and a nutrition plan must be provided to both the donor and recipient.
“Transplant centers must make a registered dietitian available to both the donor and the recipient — and their families — if requested,” DeWald said. Ongoing training must also be provided to the nursing staff who work with recipients and donors, she said. – by Mark E. Neumann
DeWald G. Session 122. Presented at: American Nephrology Nurses Association’s Nephrology Nursing Practice, Management and Leadership Conference; Oct. 12-14, 2019; San Diego.
Disclosure: DeWald reports she is a consultant with the National Dialysis Accreditation Commission.