The Kidney Transplant Program is part of Multi-Organ Transplant Program (MOTP). The Program has been active since 1969 and is located in Halifax, Nova Scotia, at the QEII Health Sciences Centre and serves the provinces of Nova Scotia, New Brunswick, Prince Edward Island, and Newfoundland.

In addition to providing patient services, the Program plays an integral role in professional and community education. These education activities take many forms, from educating community groups and nursing students to long-term strategic planning and program development.

Our goal has been to create a multidisciplinary organization consisting of two pillars, clinical and science, dedicated to serve the patients, educate the next generation and develop, direct and translate new therapeutic strategies for the future. The overall purpose of the program is to ensure that Atlantic Canadians have equitable and appropriate access to transplantation services and also to continue to improve patient care and the success of transplantation.

The mission of the MOTP is in accordance with the promise and vision of Nova Scotia Health Authority (NSHA) and its practices align with NSHA’s standard operating procedures.

The Kidney Transplant Program of MOTP performs approximately 80-100 kidney transplants yearly. Most are from deceased organ donors but about 25-40 are from living donors. The Program participates in the national Live Donor Paired Exchange Program. Approximately 5-10 of these kidneys will be combined with pancreas transplants for patients with Type 1 Diabetes Mellitus.

All patients with End Stage Kidney Disease are to be considered for a kidney transplant.

However not everyone is eligible. The Canadian Transplant Society published eligibility guidelines in The Canadian Medical Association Journal in 2005.

A patient’s nephrologist must refer a patient for consideration taking these guidelines under consideration.

A detailed evaluation is required in order to determine whether there are contraindications to transplantation.

Patient information is then referred to the Kidney Transplant Wait List committee, which is a multidiscipline committee consisting of physicians, surgeons, psychologist, social workers, and coordinators.

All decisions about listing are made by this committee. If the decision is unsatisfactory to the patient, the patient may be re-reconsidered.

Only patients who are active on the wait list have the opportunity to receive a transplant. The allocation of deceased organs is complex. Not all organs can be given to all patients.

There are issues of immunologic compatibility. That is in some cases transplantation could result in immediate rejection and these combinations must be avoided. The program uses a computer algorithm to allocate organs to those that are compatible.

Those most in need such as the high priority medically sick and those that need multiple organs (heart and liver) are selected first (medical need). Patients who are highly sensitized are also given priority. Patients that have good immunologic matches are given intermediate priorities since these transplants tend to work longer (greater utility).

However most organs are allocated based on wait time on the list (equitability). Time waiting starts at the time of the start of dialysis. In addition younger organs are matched to younger recipients and older ones to older patients. The computer program is called Smartmatch and is unique to Atlantic Canada. The Program is based on the principles and recommendations from a Canadian National Consensus Forum.

The protocols (and associated Pre-Printed Orders) primarily focus on medication use as it pertains to the care of in-patient and out-patient renal allograft recipients. The protocols have been based on the most recent evidence. Included in these protocols are many recommendations from the following guidelines:

• Kidney Disease Improving Clinical Outcomes (KDIGO) Clinical Practice Guidelines for the Care of Kidney Transplant Recipients


• The Canadian Society of Transplantation


• Canadian Society of Nephrology Commentary on the 2009 KDIGO Clinical Practice Guidelines for the Care of Kidney Transplant Recipients.

In addition to clinical evidence, and especially where clinical equipoise dominates the literature, decisions to proceed with a certain course of therapy have been made based on regional limitations, logistics and preference.

The intent of these protocols is to standardize care of kidney transplant recipients as well as provide a guide to new staff and junior healthcare practitioners. The protocols do not address every eventuality and do not replace clinical judgment.