As of July 1, 2025, the Temple University Hospital Kidney Transplant Program is participating in the Increasing Organ Transplant Access (IOTA) Model in collaboration with the Centers for Medicare & Medicare Services (CMS) Innovation Center to support chronic kidney disease care.

The IOTA Model aims to increase access to kidney transplantation and the number of kidney transplants, improving health outcomes for people with end-stage renal disease. The focus is on improved care coordination for those seeking kidney transplant evaluation, or on the kidney transplant waitlist, and enhancing outcomes for transplant recipients.

Candidacy Criteria

The following information is used to determine patient’s candidacy to be placed on the organ transplant waiting list. All patients with end-stage renal disease are individually reviewed to determine their candidacy for kidney transplantation.

In accordance with regulatory requirements, the transplant center must use written patient selection criteria in determining a patient’s suitability for placement on the waiting list or a patient’s suitability for transplantation.

Patient selection criteria must ensure fair and non-discriminatory distribution of organs.

Prior to placement on the center’s waiting list, a transplant candidate must meet the following requirements:

• Age ≥ 18 years
• ESRD and on Chronic Maintenance Dialysis
• Chronic Kidney Disease with eGFR </= 20 ml/min
• Chronic Kidney Disease with eGFR </= 30 ml/min and indication of other solid organ

Relative Contraindications

• Psychosocial instability that would interfere with adherence.
• Significant peripheral vascular disease
• Recent cardiovascular and/or cerebrovascular disease
• Pulmonary disease requiring supplemental oxygen
• Current use of long-term anticoagulation
• Hypotension and/or regular use of midodrine
• Use of medications that present metabolic contraindications with immunosuppression for which there is no alternative
• Active, symptomatic GI diseases such as diverticulitis, pancreatitis, hepatitis
• Gastrointestinal malabsorptive states
• Active viral infections
• Indolent and low-grade cancers such as prostate cancer (Gleason Score < 6) and incidentally detected renal tumor (< 5 cm in maximum diameter)
• History of malignancy with unacceptable risk for recurrence
• Hematologic malignancies, unless they received a potential curative treatment and are in stable remission
• BMI >35
• Financial situation such that reliably accessing immunosuppressive medications and care would not be possible
• Patients with a history of substance use disorder (other than marijuana or prescribed drugs) are required to enroll in and complete an approved treatment program prior to listing
• Psychiatric disorders where the patient is not under the care of a psychiatrist and/or following their recommendations or at unacceptable risk of non-adherence post-transplant

Absolute Contraindications

• Active bacterial or fungal infections not responsive to therapy
• Decompensated cirrhosis
• Active malignancy other than noted above
• Severe, uncorrectable cardiac or vascular disease
• Severe uncorrectable obstructive or restrictive lung disease (as kidney alone)
• Progressive central neurodegenerative disease
• Severe uncontrolled hematologic disorders
• Uncontrolled coagulopathy
• Body mass index (BMI) >55

Living Kidney Donation Selection Criteria

Living donor recovery hospitals may exclude a donor with any condition that, in the hospital’s medical judgment, causes the donor to be unsuitable for organ donation. Living donor recovery hospitals must exclude all donors who meet any of the following exclusion criteria:

Absolute Contraindications

• Is less than 18 years old
• Mentally incapable of making an informed decision
• Active malignancy, or incompletely treated malignancy that either requires treatment other than surveillance or has more than minimal known risk of transmission
• High suspicion of donor inducement, coercion, or other undue pressure
• High suspicion of knowingly and unlawfully acquiring, receiving, or otherwise transferring anything of value for any human organ
• Evidence of acute symptomatic infection (until resolved)
• Uncontrolled diagnosable psychiatric conditions requiring treatment before donation, including any evidence of suicidality
• Uncontrollable hypertension or history of hypertension with evidence of end organ damage
• Type 1 Diabetes
• Type 2 diabetes where an individual assessment of donor demographics or comorbidities reveals either
  • Evidence of end organ damage or
  • Unacceptable lifetime risk of complications
• History of malignancy at risk for recurrence
• Lupus
• History of MI, stroke, TIA, carotid stenosis, aneurysm (AAA, cerebral, mesenteric, or non-traumatic peripheral), CABG (Coronary Artery Bypass Graft), carotid endarterectomy, or peripheral or central vascular bypass operation
• Cirrhosis or portal hypertension

Relative Contraindications

• BMI > 40
• BMI >50 for NKR, will review in committee for appropriateness
• GFR < 80
• Hypertension
  • Some donors with hypertension on a single first line antihypertensive agent may be acceptable
• Cardiovascular disease
• Obstructive or restrictive lung disease
• History of DVT or PE or evidence of hypercoagulable or hypo-coagulable state
• Psychiatric disorders
• Substance abuse
• Kidney stones
• Proteinuria
• Evidence of glomerular disease
• Roux-en-Y gastric bypass
• Non-compliance with our recommendations
• Pregnancy or childbirth within 1 year of donation

Offer Acceptance Criteria

When evaluating a potential organ offer, our transplant team considers several medical and logistical factors to ensure the best possible clinical outcome. These include, but are not limited to:

• Donor age, social and medical history
• Cause of donor death and organ function (e.g., kidney function tests, kidney biopsy results)
• Compatibility with your blood type and tissue match
• Donor kidney quality metrics such as the Kidney Donor Profile Index (KDPI)
• Infectious disease screening and infection risk profile
• Cold ischemia time (how long the kidney is on ice and preserved) and organ transportation logistics
• Recipient-specific considerations (e.g., other health risk factors, surgical risk, time on the waitlist, and readiness)

The Temple University Hospital Kidney Transplant Program may also review other organ offers, such as those from donors with hepatitis B or C, or from donors with increased risk for certain infections, in accordance with federal regulations and patient documented consent.

Please note that the transplant team makes each decision on a case-by-case basis, balancing medical urgency, organ quality, and safety to provide the best opportunity for a successful transplant.