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©2013 UpToDate ® Print Email Canadian Society of Transplantation consensus guidelines on eligibility for kidney transplantation General considerations Recommendations 1. All patients with end-stage renal disease should be considered for kidney transplantation provided no absolute contraindications exist (Grade A). 2. Eligibility for kidney transplantation should be determined on medical and surgical grounds. Criteria for eligibility should be transparent and made available to patients and the public. Eligibility should not be based on social status, gender, race or personal or public appeal (Grade C). 3. A patient declined for transplantation should routinely be offered a second opinion from an alternative physician or surgeon or a committee able to assess the relative risks and benefits of kidney transplantation (Grade C). Timing of referral Recommendations 1. Potential transplant recipients should be referred for evaluation by a transplant program once renal replacement therapy is expected to be required within the next 12 months (Grade C). 2. Patients already requiring dialysis support should be referred for transplant evaluation as soon as their medical condition stabilizes (Grade C). Renal function Recommendations 1. Preemptive kidney transplantation is the preferred form of renal replacement therapy and should be encouraged where feasible (Grade A). 2. Preemptive kidney transplantation should not proceed unless the measured or calculated glomerular filtration rate is <20 mL/minute and there is evidence of progressive and irreversible deterioration in renal function over the previous 6-12 months. Exceptions may be made for patients receiving combined organ transplants where a kidney transplant is combined with a non-renal organ. However, the appropriate policy on this issue is not clear at this time (Grade C). Age and functional capacity Recommendations 1. Advanced age per se is not a contraindication to kidney transplantation (Grade B). 2. Transplant candidates should have a reasonable probability of surviving beyond current waiting times for transplantation, given the resources required to assess and maintain patients on the renal transplant waiting list (Grade C). 3. Very young age and small size should not prevent early referral for transplant evaluation (Grade B). 4. Cognitive or neurodevelopmental delay is not an absolute contraindication to renal transplantation in children (Grade B).

2. Transplant candidates should have a reasonable probability of surviving beyond current waiting times for transplantation, given the resources required to assess and maintain patients on the renal transplant waiting list (Grade C). 3. Very young age and small size should not prevent early referral for transplant evaluation (Grade B). 4. Cognitive or neurodevelopmental delay is not an absolute contraindication to renal transplantation in children (Grade B). * The strength of evidence supporting each recommendation was graded using the system developed by the Canadian Task Force on Preventive Health Care as follows: Grade A - There is good evidence to support Grade B - There is fair evidence to support Grade C - The existing evidence is conflicting, but other factors may influence decision-making Grade D - There is fair evidence to recommend against Grade E - There is good evidence to recommend against Reproduced with permission from: Knoll, G, Cockfield, S, Blydt-Hansen, T, et al. Canadian Society of Transplantation: Consensus guidelines on eligibility for kidney transplantation. CMAJ 2005; 173:S1. Copyright © 2005 CMA Media Inc.