Consent for kidney transplant
PATIENT DETAILS
| Patient name | Date of birth | ||
| CHI number | Sex | ||
| Special requirements | |||
STATEMENT FOR PRACTITIONER
(to be filled in by practitioner with appropriate knowledge of proposed procedure)
You are being asked to give your consent to the staff in the Glasgow Renal and Transplant Unit for kidney transplantation and the use of immunosuppressive drugs.
General information about kidney transplants
This procedure is being offered as a treatment of kidney disease, and is an alternative to dialysis. Treatment with medicines that affect the immune system will be required for the duration of the transplant and you should understand that there are risks associated with this treatment. Your attention is particularly drawn to the following:
- You will need to take medicines to prevent the kidney from being rejected. These may include steroid tablets or injections and drugs such as tacrolimus, mycophenolate, azathioprine and sirolimus. The side effects of these medicines can include kidney dysfunction, high blood pressure, diarrhoea, hair growth, or hair loss and a low white cell or platelet count. Regular attendance at the clinic is essential to monitor these medicines.
- Occasionally “rejection” occurs despite taking prescribed medicines and it is more likely if they are missed. This is usually treated with steroid injections and sometimes with antibody or other therapies. Rejection rarely (<5% of patients in the first year) causes the transplant to fail.
- Immunosuppressive medicines increase the risk of infection, especially urine infections and chest infections. Sometimes serious infections occur which are not common in people with normal immunity, such as viral infections (e.g. CMV) and pneumocystis infection. You may be asked to take preventative medicine to reduce the risk of infection.
- There is a small risk of infection being transmitted with the kidney. This can include bacterial, viral, fungal or other infections which were not apparent at the time of donation. Very rarely cancer can be transmitted with the kidney. Extremely rarely allergies can be passed from the donor, including serious allergies such as peanut allergy.
- In the long term immunosuppression increases the chance of cancer. The most common cancers in transplant patient are skin cancers and precautions to avoid sun exposure are recommended. After a successful transplant you will be offered the opportunity to attend a dermatology clinic for skin surveillance. Cancers of blood cells (“lymphoma”) may also occur and other cancers such as lung cancer or bowel cancer are also more common.
- Kidney transplants are major surgical operations, and complications of surgery can occur. These include general surgical complications such as infection, bleeding, thrombosis of the deep veins, pulmonary embolism. There are also specific complications such as damage to blood vessels, arterial or venous thrombosis, urine leaks, ureteric strictures, lymphatic fluid leaks and fluid collections.
- There is a small risk of serious and life-threatening complications including heart attacks, stroke and death. For a patient of your age group, the risk of death in the postoperative period is {{age_risk}}.
- Although in about 90% of cases the kidney works well, some kidneys don’t work either for reasons to do with the donor, or due to post-operative complications like clotted blood vessels or problems with the ureter.
- Kidneys from deceased donors can be slow to work and a period of dialysis may be required. The risk of this occuring varies from 30% in kidneys from donors after brainstem death to around 90% in donors after circulatory death.
- In about 90% of transplants of this type the kidney is slow to work and a period of dialysis may be required before it does. Transplants from living donors or donors after circulatory death are more likely to function immediately.
- In about 30% of transplants of this type the kidney is slow to work and a period of dialysis may be required before it does. Transplants from living donors are more likely to function immediately.
- In about 10% of transplants of this type the kidney is slow to work and a period of dialysis may be required before it does. In contrast, kidneys from deceased donors are less likely to work immediately.
- We may remove your peritoneal dialysis catheter at the start or end of the transplant operation, depending on how the kidney reperfuses and on whether the catheter is in the way of the incision. If you need dialysis after the operation, it will need to be via a temporary line. If the transplant fails, it may be possible to switch back to peritoneal dialysis in the future but sometimes it is necessary remain on haemodialysis on a long term basis.
- In the rare event that the kidney transplant fails, you may need to start long-term dialysis immediately and may require further operations or procedures to establish access for dialysis.
- A temporary haemodialysis catheter may be needed to provide access for dialysisif your normal haemodialysis access is not working well when you are admitted for the transplant. This is usually inserted into a large vein in the neck, and can usually be done while you are under the anaesthetic for the transplant. Complications due to insertion of a temporary haemodialysis catheter are rare, but can include bleeding and the formation of a pneumothorax (air trapped between the lung and chest wall.
- Kidney transplants do not usually last forever, and will eventually fail due to chronic inflammation, the effect of antibodies, recurrence of the original disease in the kidney or the development of a new disease of the kidney.
- Kidneys from living donors have the best expected survival, and half of them function for more than 15 years after the transplant.
- Kidneys from deceased donors do not function as well as living donors, but half are still working more than 10 years after the transplant
- Some patients develop diabetes after a transplant. Patients who are already diabetic may find their sugars harder to control and need to take more medication for this, which may include insulin injections.
- Some patients develop diabetes after a transplant. This would mean your blood sugar level is harder to control and need to take more medication for this, which may include insulin injections. Your risk of developing diabetes is higher than average.
- Transplant medications affect diabetes treatment. Your blood sugars will be harder to control after the transplant and need to take more medication for this, including increasing doses of insulin.
- Transplant medications affect diabetes treatment. Your blood sugars will be harder to control after the transplant and you may need to take more medication for this, which may include insulin injections.
- To protect the join between the ureter and the bladder, a plastic tube called a stent will be placed in the tube from your kidney to the bladder. This will need to be removed approximately 6 to 8 weeks after the transplant, which is a minor procedure usually done as a day case under local anaesthetic.
Special considerations for this transplant
The donor of this kidney has been tested and is not known to havemay have Coronavirus (Covid-19), but there is a small risk that the donor may have had the infection, however the risk of passing the infection on to a transplant recipient is believed to be very low. If you catch coronavirus, it can cause serious or life-threatening infection with your anti-rejection medication, so it is important to take precautions such as mask wearing in indoor or crowded areas, even if vaccinated. Getting fully vaccinated before starting anti-rejection medication more effective at reducing risk, and you may want wait until you have received both vaccine doses; choosing not to go ahead with this transplant will not affect your chances of a further offer in the future. We are seeing some severe infections even in fully vaccinated transplant patients, so you may want to wait until you have received your booster dose as it will be more effective before you are on immunosuppression; choosing not to go ahead with this transplant will not affect your chances of a further offer in the future..
The kidney comes from donor with evidence of hepatitis C infection. This infection can be passed on with the kidney, so if you accept this kidney you will need additional monitoring to look for infection and may need additional antiviral drugs to treat the infection. International experience suggests that more than 95% of patients given the anti-viral drugs will be cured of the infection, but of those who are not cured, some may go on to develop liver failure and even may need a liver transplant.
Your transplant is to come from the National Kidney Sharing Scheme, so your kidney will come from another living donor. There is a very small chance that after your donor has donated a kidney, you do not receive a transplant. In the very unlikely event that this happens, you would be prioritised on the deceased donor waiting list.
There is a higher risk of rejection than average, so you will receive additional immunosuppressant (anti-rejection) medication. This increases the risks of immunosuppression, including infections and malignancies.
There are arteries on the kidney. This slightly increases the risk of a clotted artery, which may cause the loss of some or all of the kidney, or complications with the ureter.
The kidney donor had acute kidney injury before donating their kidney. This is expected recover but it may take some time before the kidney starts to function. There is an approximately 5% chance that kidney will not recover and the transplant will fail. There is also a chance that the kidney may only partially recover and not manage to function to the fullest extent.
This kidney has come from an elderly donor. Older kidneys do not tend to work as well as kidneys from younger donors, and tend not to function for as long. There is also an increased risk of transmitting a tumour from the donor as most cancers are more common with older age.
As the donor had relatively poor kidney function, we believe one kidney will not provide you with enough kidney function and so we will transplant both kidneys from the donor. This means a bigger operation with a higher risk of wound complications and there may be a scar on both sides of the abdomen.
The kidneys have come from a small child with small arteries at high risk of clotting. We can reduce this risk by transplanting the two kidneys together so we can use the larger artery and vein. The operation is more complex than normal but can lead to very good long term function as children's kidneys usually work very well.
The kidney donor had died from vaccine-induced thrombocytopaenia and thrombosis (VITT), a very rare complication of COVID-19 vaccination. The risk of this being passed on from a donor to a kidney recipient is believed to be low, but there is a possible risk of severe bleeding or clotting. Some additional blood tests will be needed and we will need to send additional data to the national registry.
A biopsy of the kidney may be taken at retrieval for research. and to assess the kidney for suitability for transplant. We may also take a biopsy during the transplant operation, to provide additional information that may be useful in your post-transplant care. This is a generally safe procedure, but there is a 0.5% 0.1% risk of complications including bleeding, damage to blood vessels inside the kidney and urine leaks.
Practitioner's statement
I have explained the procedure named on this form to the patient in terms which, in my judgement, are suited to their understanding. In particular, I have fully explained: the intended benefits; appropriate alternatives which are available (including no treatment); any significant risks which may result from the procedure; and any extra procedures which may become necessary during the procedure (please specify major procedures above).
| Signature of practitioner | |
| Name and status | / |
| Date: | 12/05/2026 |
(Consent form for {{patient_name}} {{patient_chi}})
STATEMENT TO BE COMPLETED BY PATIENT
You should read this form and the notes below carefully. If there is anything you do not understand ask the Practitioner for an explanation. If the information is correct and you understand the procedure, you should sign the form. You have the right to change your mind at any time, including after you have signed this form.
I understand:
- The procedure, important risks and appropriate alternatives which have been explained to me by the practitioner named on this form.
- That a practitioner other than the practitioner who has been providing treatment so far might carry out the procedure.
- That any procedure in addition to that named on this form will only be carried out if it is necessary and is reasonable in the circumstances, in relation to the medical treatment proposed, to safeguard or promote physical or mental health.
- That examination for the purpose of teaching will not be undertaken without my consent.
I have been told about additional procedures which may become necessary during treatment. I have listed below any procedures which I do NOT wish to be carried out without further discussion.
I agree:
- to the administration of a general anaesthetic
- the administration of supplementary local anaesthetic, including regional blocks
- to the procedure named on this form
- to the emergency administration of blood or blood products
| Additionally you have to agree or disagree the following:- | Agree | Disagree |
|---|---|---|
| that information and/or images kept in records may be used anonymously for education, audit, and research with appropriate ethical approval, to improve the quality of patient care. | ||
| that surplus tissue or other biological material not essential for my diagnosis or future treatment may be used for medical education and ethically approved medical research. |
PATIENT CONSENT TO TREATMENT
| Signature: | Date: 12/05/2026 |
| Name: | CHI: |
PATIENT REFUSAL OF BLOOD PRODUCTS
Please sign here if you refuse to consent to the emergency administration of blood or blood products, even if this results in death.
| Patient signature: | Date: 12/05/2026 |
| Clinician signature: | Date: 12/05/2026 |