What are the key indications for referring a patient for organ transplantation in primary care?

In primary care, key indications for referring a patient for potential organ transplantation primarily relate to progressive chronic kidney disease (CKD) and severe liver disease, where specialist assessment is required.

• Chronic Kidney Disease (CKD): Patients with CKD who are likely to need renal replacement therapy (RRT), which includes transplantation, should begin assessment for RRT at least one year before therapy is anticipated to be needed NICE NG107. Primary care should provide adults with CKD information about their 5-year risk of needing RRT, using tools like the 4-variable Kidney Failure Risk Equation NICE NG203. Discussions about the individual factors affecting the risks and benefits of transplantation, including living donor transplantation and pre-emptive listing for deceased donor transplantation, should be initiated with all people who are likely to need RRT NICE NG107. Patients should not be excluded from kidney transplant consideration based on Body Mass Index (BMI) alone NICE NG107.
• Liver Disease: For patients with signs of decompensated liver disease or cirrhosis diagnosed on transient elastography or other imaging, an emergency hospital admission or immediate referral to a hepatologist or gastroenterologist with an interest in hepatology should be arranged NICE CKS. The specialist will then assess suitability for liver transplantation NICE CKS.
• Deceased Organ Donation: It is important to note that the identification of potential deceased organ donors, typically in end-of-life care following catastrophic brain injury or intention to withdraw life-sustaining treatment, occurs in critical care settings and involves discussion with a specialist nurse for organ donation NICE CG135. This is distinct from referring a living patient for transplantation.