Status

This policy addresses kidney transplantation (from deceased or living donors). It is medically necessary for selected individuals with end-stage renal disease who meet clinical indications and general transplant selection criteria; candidates must also lack contraindications per American Society of Transplantation guidelines. It is not medically necessary for conditions other than ESRD or for simultaneous liver–kidney transplantation when SLK criteria are not met; for multi-organ requests, criteria must be met for each organ, with individual case review.

"Note:Members must meet the clinical indications as well as the general individual selection criteria for the transplantation to be considered medically necessary."

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