The Centers for Medicare & Medicaid Services (CMS) has selected Loma Linda University Medical Center to participate in the Increasing Organ Transplant Access (IOTA) Model. The IOTA Model aims to increase access to life-saving transplants for patients with end-stage renal disease (ESRD) and reduce Medicare expenditures.
 
 
 
 

Recipient Selection Criteria

Transplant Eligibility

  1. End stage renal disease
  2. eGFR ≤ 20
  3. Candidates with eGFR > 20 that have potential living donors, may start workup when candidate eGFR ˂ 30. Transplant surgery will be scheduled when recipient eGFR ≤ 20
  4. Candidates with a eGFR ≤ 25 and a TANGRI score > 40 may be placed on the waiting list and will be closely monitored for a eGFR ≤ 20
  5. Financial coverage and authorization for transplant evaluation, procedure, and outpatient follow-up care

Absolute Recipient Contraindications

  1. Body Mass Index (BMI) > 50 kg/m2
  2. Presence of active infection
  3. Active substance abuse
  4. Advanced cardiovascular disease
  5. Presence of advanced malignancy (excluding non-melanoma skin cancer)
  6. Active infected wound based on clinical observation
  7. Advanced pulmonary disease
  8. Advanced liver disease (if not eligible for liver transplant)
  9. Severe peripheral vascular disease
  10. Lack of social support system
  11. Active systemic disease (i.e. Systemic lupus, Wegener’s, sickle cell)
  12. Conditions that affect adherence that would significantly impair the patient’s ability to comply with the complex pre and post-transplant medical regimen
  13. Patient choice not to participate or proceed with the transplant process (e.g. evaluation, procedure, outpatient follow-up)
  14. Comorbidities that would reduce the benefit of transplant, including patient survival and continuing function of the implanted kidney

Relative Recipient Contraindications

  1. BMI > 40-50 kg/m2
  2. Recent substance abuse (within 6 months)
  3. Active or recent (within 1 month) nicotine or tobacco use
  4. History of malignancy
  5. Inadequate social support system
  6. Poor functional status
  7. Age ≥ 70 without a viable living donor

Living Kidney Donation Selection Criteria

Living Kidney Donation Absolute Contraindications

  1. Age < 18 years old 
  2. Mentally incapable of making an informed decision 
  3. Body mass index ≥ 35 kg/m2 
  4. Active Diabetes Mellitus 
  5. Corrected GFR <80 mL/min 
  6. Proteinuria (>200 mg/24 hr collection) 
  7. Chronic respiratory disease with impairment of oxygenation or ventilation 
  8. Symptomatic cardiac valvular disease 
  9. Peripheral vascular disease 
  10. Hepatitis B and/or hepatitis C virus infection 
  11. Pregnancy 
  12. History of recent malignancy (exception: non-melanoma skin cancer) 
  13. Urological abnormalities prone to kidney damage (high risk) 
  14. Hypertension treated with 3 agents 
  15. Active hypertension in African Americans 
  16. Reno-vascular disease (e.g., fibromuscular dysplasia) 
  17. Sleep apnea with pulmonary hypertension 
  18. Active alcoholism and/or drug abuse 
  19. Active and uncontrolled psychiatric conditions 
  20. Maladaptive emotional/behavioral responses 
  21. High suspicion of donor coercion 
  22. High suspicion of illegal financial exchange between donor and recipient 

Living Kidney Donation Relative Contraindications 

  1. Body mass index >30 kg/m2 
  2. Hypertension treated with 2 or less agents 
  3. Coronary artery disease 
  4. Active tobacco use 
  5. Urological abnormalities (e.g. proteinuria 151-200 mg/g, hematuria) 
  6. HIV infection 
  7. Recent or recurrent clinical/symptomatic kidney nephros 
  8. Autoimmune disease that could negatively impact patient or graft survival