Unidad III: Infraestructura como Servicio bajo la plataforma

Trust Headed Paper [include contact details for living donor co-ordinator]

[Name and address (overseas) of potential donor] Hospital No/ID (if available)

NHS No (if available) Date of Birth

Dear [Donor‟s name]

RE: PROPOSED LIVING KIDNEY DONATION FOR UK RECIPIENT:

(NAME, HOSPITAL ID, DOB, ADDRESS IN UK)

We understand that you wish to be considered as living kidney donor for your [relationship donor to recipient].

Thank you for providing us with some preliminary medical information, which indicates your suitability for proceeding to the next stage of the donation process. To ensure a thorough assessment of your medical suitability to donate a kidney and so that you have an opportunity to discuss this in detail, you will need to travel to the United Kingdom (UK) to attend [‟X‟] Hospital, [Name of City/Town] for further tests and consultations. As you know, we have provisionally organised for you to attend for these appointments starting [Day, Date] and so you should request a visa to start as close to this date as possible and then arrange your travel accordingly (see below). Please read this letter carefully before proceeding any further.

Next Steps:

1. Your application to travel to the UK

To travel to, enter and stay in the UK for 6 months you will need to satisfy UK immigration requirements. You will need to make an application to your local British Diplomatic Mission for a UK Visitor‟s Visa (entry clearance), specifying your intention to donate an organ for your relative. Your relative, the potential recipient of your kidney, must ordinarily be resident

182 in the UK and entitled to kidney transplant treatment on the National Health Service (NHS). Your relative must check this information with the hospital in the UK before you submit an application, otherwise it will not be valid.

You will find all the information you require to apply for your visa on the UK Border Agency Visa Services website: http://www.ukvisas.gov.uk/en/ or at your local British Diplomatic Mission. To avoid unnecessary delays in processing your application, which will be referred to the UK for a decision by your local British Diplomatic Mission, you should ensure you read the information carefully before completing your application to make sure you provide all the necessary information needed to satisfy the requirements set out in the guidance and here in this letter. This should avoid any unnecessary delays or uncertainty about travel dates. As your visa application will be considered in the UK, you should allow at least 4 weeks (maximum 12 weeks) from the time of application. If successful, your visa will then be issued for 6 months, starting on the date you have agreed with us and as stated on the visa application form.

2. Your medical testing and donation in the UK

We need to plan your further medical assessment and surgery carefully and in advance, in order to ensure we complete the kidney donation process within 6 months. Once you have completed the assessments in the UK, we will be able to confirm whether or not you are a suitable donor and, if you still wish to donate, we will schedule a date for the living donor transplant operation for you and your recipient as soon as possible. You will need to recover in the UK after the surgery for up to 4 weeks before you travel back to your own country. You must arrange to stay with your family throughout your stay in the UK, or make independent accommodation arrangements before your arrival in the UK (you will have to provide evidence of this in your visa application to travel to the UK). It is particularly important to make sure that you can stay with your family when you are discharged from hospital so that you are not living alone while you recover from your surgery.

3. Your checklist to proceeding

To help us plan everything as smoothly as possible for you with the minimum of delay, you can help us by doing the following:

1. Ensure you have discussed with the hospital when you wish to travel to the UK before submitting your application. This is essential in order to allow enough time for the hospital to arrange your tests in advance, to start as soon as possible after your arrival in the UK and to provide you with enough time to recover and convalesce after your operation. Prior to this discussion you should consider the date that you think you will be able to make travel plans and UK reception arrangements (staying with your family). You will need to allow at least 4 weeks (but no more than 12 weeks) between the date you intend to submit your visa application to the British Diplomatic Mission and the date you wish to travel. Once this information has been discussed and agreed with the hospital you will have a date and all the relevant information for your visa application.

183 2. Follow the guidance on the website when applying for your visa to ensure that you have met the UK Border Agency requirements in full before you submit your application. 3. Attach this letter to your visa application, and submit it together with all your other documents for your visa application to your local British Diplomatic Mission for consideration by an Entry Clearance Officer. If your application is approved, your visa will be issued to start on the specified date, previously agreed with the hospital. Please keep a copy of all these documents for yourself for future reference.

4. It is your responsibility to advise the hospital directly if there is any delay in submitting your visa application to your local British Diplomatic Mission overseas or in approving it so that we know when to expect you and to adjust dates accordingly.

Costs

It is important that you know which costs and expenses are covered during your visit. The cost of your medical treatment specifically for the purposes of donating a kidney (donor assessment, +/- donor surgery and out-patient appointments) will be covered by the NHS whilst you are in the UK, but this is not available to you once you have returned to your own country at the end of the 6 month period. Whilst you are in the UK, any treatment outside of the donor process, including dentistry, is not covered by the NHS and, if you do not have medical insurance, you will be expected to pay for this yourself or return to [Country of residence for donor] for treatment. You are, therefore, advised to obtain medical insurance before you travel. You are entitled to apply for reimbursement for travel and living expenses specifically in connection with process of donation from the NHS once you have donated your kidney and you are advised to keep a record of expenses that you incur. If you are unable to proceed with the donation as planned following assessment in the UK, you will not be entitled to claim these expenses.

Please ensure that you and your family have read this letter and fully understand the information before proceeding with a visa application. I will be co-ordinating your donor assessment at the hospital. Please contact me directly or via your recipient if you are not clear about any aspect of this letter. My contact details are at the top of this letter.

Yours sincerely

Living Donor Co-ordinator/member of Transplant/Referring Team

184

CHAPTER 10

DONOR FOLLOW-UP

Statements of Recommendation

Life-long follow-up is recommended after donor nephrectomy. For donors who are resident in the UK, this should be offered locally or at the transplant centre according to the wishes of the donor, but such arrangements must facilitate the collection of data for submission to the UK Living Donor Registry on long term morbidity and mortality. Donors from overseas who travel to the UK to donate are not entitled to follow-up in the UK but should be given advice about appropriate follow-up before returning to their country of origin (C1)

Arrangements must be put in place to ensure that the unsuitable donor, who is unable to proceed to donation, is appropriately followed-up and referred for further investigation and management. (B1)

NHSBT has given a formal undertaking that any living kidney donor who develops renal failure in the peri-operative period as a consequence of donation will receive priority for a deceased donor kidney transplant. (Not graded)

10.1 Arrangements for Follow-up

Early follow-up of the donor is recommended within the first few weeks after surgery to ensure that he or she is making progress following the operation and is appropriately supported. This should include monitoring of kidney function as well as the early detection of problems such as infection and wound healing. By the end of three months it is anticipated that the donor will have made a full recovery and have returned to normal activities. Some centres offer a further review at this stage as an opportunity to ensure that this has happened as well as offering ongoing support and advice for continued optimal health.

185 Long term follow-up, on an annual basis, provides a forum for review of kidney function, urinalysis and blood pressure as well as general health status. Existing guidelines based upon a consensus of professional opinion recommend that the transplant centre has a responsibility to encourage and facilitate the long term follow-up of the donor after donation, particularly for individuals with pre-existing or acquired conditions that potentially place them at greater risk (1-3). These include hypertension, obesity, diabetes and proteinuria (see Figure 10.1 for a suggested model for donor follow-up). This follow-up can be provided by the transplant centre, the referring nephrology unit or the donor‟s General Practitioner. Whilst not all donors wish to return for regular review, anecdotally many welcome the opportunity and appreciate the continuing support and interest in their welfare.

In the event of an unsuccessful transplant, it is particularly important to provide adequate emotional as well as physical support for the donor, including access to counselling facilities (see Chapter 4). Practice with respect to long term follow-up still varies between centres and is subject to local arrangement. The principle of long-term surveillance and monitoring of the donor is considered to be best practice and is encouraged in the UK by the National Living Donor Registry, which was established in 2000 and is held by NHS Blood & Transplant (5). All UK centres are expected to submit data to the Registry on all donors at specified time points both pre-and post donation in order to optimise the value of the Registry Data in informing living donor practice. In developing models of care for donor follow-up, timing of annual review in accordance with the month of donation, offering flexible clinic times and local follow-up arrangements should be considered in order to offer choice to the donor and facilitate the timely collation of Registry Data for willing participants. Annual review telephone clinics may be less suitable for long-term donor follow-up due to the infrequency of the interaction with a healthcare professional. Anecdotal feedback from previous donors when offered this option in a single centre was not favourable on the basis that the annual face-to-face consultation is of intrinsic value to the follow-up experience.

186

Figure 10.1