Discharge proforma for non-proceeding transplant

Patient details

Patient age

Patient sex Male Female

CKD stage ESRF Stage V CKD

Primary renal diagnosis

Dialysis modality? Hospital haemodialysis Home haemodialysis CAPD APD Peritoneal dialysis Failing transplant

Renal unit QEUH GRI Stobhill ACH Victoria ACH Inverclyde Vale of Leven Forth Valley Monklands Crosshouse Dumfries & Galloway Other

Other unit

Potential transplant details

Donor type DBD DCD Living donor (direct) Living donor (NKSS) Living donor (altruistic)

Reason did not proceed Prolonged time to asytole Collapsed NKSS chain Recipient acute illness / unfit Recipient declined Tx Donor comorbidity Problem with kidney

Describe reason

Review of suitability

Suspended from waiting list Remains active on list Suspended for fixed period Suspended indefinitely

Duration of suspension

Suspension reason

Actions for referring nephrologist

Follow-up

Tx assessment clinic review No Yes

Actions for GP

Text to copy/paste into letter

Patient: {{age}} {{sex}} with {{ckd_stage}} due to {{primary_renal_diagnosis}} on {{dialysis_modality}} at with a failing transplant, referred from referred from {{referring_unit}}, was admitted for a potential {{donor_type}} transplant but unfortunately the transplant did not proceed due to {{np_class2}}.

Reason did not proceed: {{np_comments}}

Transplant listing status: {{listing_status}} {{suspension_duration}}

Reason for suspension: {{suspension_comments}}

Follow-up: will also be reviewed in the Transplant Assessment clinic in Glasgow and usual follow-up in local renal unit at {{referring_unit}}

Actions for referring renal unit: None {{clinic_actions}}

Actions for GP: None {{gp_actions}}