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