Backbench op note

Kidney

Kidney side Left Right

ODT number

HTA Form A number

EOS hospital code

Retrieval team

Timings

Date kidney arrived

Time kidney arrived

Time patient sent for

Time backbench started

Time backbench complete

Timings comments

Kidney quality

Perfusion quality Good Fair Patchy Poor None

Perfusion comments

Retrieval Biopsy? Yes No

Number of biopsies

Biopsy site

Biopsy site closed by retrieval surgeon implant surgeon

Biopsy site closure

Biopsy comments

Anatomy normal? Yes No

Pathology? Yes No

Retrieval damage? Yes No

Number of arteries

Number of patches

Arteries on patch

Arterial pathology Yes No

Atherosclerosis Yes No

Renal artery stenosis Yes No

Intimal flap Yes No

Arterial damage Yes No

Cut to renal artery Yes No

Complete transection Yes No

Artery cut off patch Yes No

Artery comment

Number of veins

Vein damaged? Yes No

Cut/tear to vein Yes No

Vein transected Yes No

Cava included Cava not included Cava included

Caval tube made Caval tube made No caval tube made yet

Cava comments

Vein comment

Number of ureters

Length of ureter (cm)

Ureter comment

Parenychma pathology Yes No

Cysts Yes No

Cyst type Simple Haemorrhagic

Number of cysts

Size of largest cyst

Cyst comment

Tumours Yes No

Number of tumours

Size of largest tumour

Tumour comment

Parenychma damage Yes No

Capsular tear(s) Yes No

Subcapsular haematoma Yes No

Parenchymal rupture Yes No

Parenchyma comment

Grade of damage None Minor - no repair needed Major - surgical repair needed to make transplantable Organ untransplantable due to damage

Comments on damage

Retrieval communication No concerns Incomplete communication Inaccurate communication

Communication comments

Perfusion in centre

Did kidney come into contact with perfusion fluid after receipt? Yes No

Perfusion fluid

Batch numbers

Machine perfused in recipient centre? Yes No

Machine perfusion type Normothermic Hypothermic

Oxygenated perfusion? Yes No

Machine used

Perfusate flow (ml/min)

Perfusion fluid

Fluid batch numbers

Perfusion fluid blood haemoglobin solution perfluorocarbon

Fluid batch numbers Blood unit numbers

Time started MP

Time finished MP

Additional flush after MP? Yes No

Perfusion fluid

Batch numbers

Machine perfusion comments

Suitability for transplant

Suitable for transplant? suitable for transplant not suitable for named recipient not suitable for transplant

Reason for opinion

Backbench procedure

Details:

Op note text

Backbench preparation of {{kidney_side}} kidney from donor with ODT number {{odt_number}}, HTA Form A number {{hta_a_number}} and EOS hospital code {{eos_hc}}, retrieved by {{retrieval_team}} NORS team. {{retrieval_communication}}. {{retrieval_communication_comments | sentence}}

Kidney arrived on {{arrival_date | date:'dd/MM/yyyy'}} at {{arrival_time | date:'HH:mm'}}. Patient sent for at {{pt_sent_for_time | date:'HH:mm'}}. Backbench preparation started at {{backbench_start | date:'HH:mm'}} and completed at {{backbench_complete | date:'HH:mm'}}. {{timing_comments | sentence}}

Perfusion quality: {{perfusion_quality}}. {{perfusion_comments}}

Retrieval biopsy: No Yes, {{ret_Bx_number}} taken at retrieval. Biopsy taken from {{ret_Bx1_site}} and closed by {{ret_Bx1_closedBy}} using {{ret_Bx1_closure}}. {{ret_Bx_comments}}.

Renal artery: {{num_arteries}} arteries on {{num_patches}} patches, with {{num_artOnPatch}} arteries on the main patch. There was some atherosclerosis. There was renal artery stenosis. There was an intimal flap. The artery had been cut. The artery had been transected The artery had been cut off the patch. {{artery_comment}}.

Renal vein: {{num_veins}} veins. The vein had been cut. The vein had been transected. {{cava_status}} and a caval tube was made. and has been preserved to allow for a caval tube to be made if needed. {{caval_comments | sentence}} {{vein_comment}}.

Ureter: {{num_ureters}} ureters with length {{ureter_length}}. {{ureter_comment | sentence}}

Parenchyma: parenchyma appeared normal. There were {{num_cysts}} {{cyst_type}} cysts. The largest cyst was {{cyst_size}}. {{cyst_comment | sentence}} There were {{num_tumours}} tumours, largest {{tumour_size}}. {{tumour_comment | sentence}} There were capsular tears. There was a subcapsular haematoma. There was a parenchymal rupture. {{KParenchymaComment | sentence}}

Kidney damage grade: {{damage_grade_full}}

Kidney damage comments: {{damage_comments}}

Perfusion in centre: No Yes, with {{impCent_PerfFluid}}, batch {{impCent_fluid_batch}}.

Machine perfused: No oxygenated {{impCentMPType}} machine perfusion with {{LKMPmachine}}, starting at {{impCentMPStart | date:'HH:mm'}} and finishing at {{impCentMPFinish | date:'HH:mm'}}. Maximum flow rate {{LKMPflow}}ml/min. {{LKNormoMPfluid}} used, fluid batch numbers blood unit numbers {{LKNormoMPfluidBatch}}. {{LKMPfluid}} used, batch number {{LKMPfluidBatch}}. After machine perfusion, the kidney was flushed with {{impCentMPFlushFluid}}, batch number {{impCent_flush_fluid_batch}}. {{impCentMPComments | sentence}}

Suitability for transplant: {{suitability}}

Reason for opinion: {{reasonwhy | sentence}}

{{backbench_opnote}}