Best Practices and Next Steps with Living Donation
- Best treatment option for late-stage chronic kidney disease (CKD) is live donor kidney transplantation (LDKT), however, living kidney donation (LKD) has stagnated and even decreased over the past 10 years.
- A living donor consensus conference was conducted in 2014 to identify best practices and knowledge gaps.
- Some of the possible reasons identified for LKD decline were, change in donor selection criteria, inadequate or uneven educational processes, an aging transplant candidate population, inefficient donor evaluation processes, poorer health of the general population, financial disincentives in an economic crisis.
Recommendations for Next Steps Summarized
- Develop philosophical approach that LDKT is the best option for most transplant candidates and standardize processes across centers.
- Educate community nephrologists and primary care physicians.
- Clarify regulations about dialysis centers’ requirements for CMS compliance regarding transplant education
- Institute transplant program quality improvement program to ensure ongoing evaluation and improvement of LDKT patient education.
- Improve LKD education processes, e.g. transplant and dialysis competencies, use technology for patient education, implement an independent, national clearinghouse.
- Expand OPTN policy on educational elements for potential live donors.
- Implement strategies to reduce disparities in LKD, e.g. culturally-tailored education, increase awareness among providers, patients, and potential living donors, conduct studies to examine disparity-reducing strategies.
- Examine program specific metrics and outcomes and compare nationally and regionally.
- Develop transplant program culture of focus on and support of LKD with timely evaluation process, dedicated staff to LKD program, referral of incompatible LKD pairs to other programs, expedited process for transplant.
- Reduce systemic barriers to LKD, such as ensuring financial neutrality for LKDs, LKD reimbursement for direct and indirect costs, consider government-private entity partnership, etc.
- Creation of LKD Financial Toolkit and LKD Educational Toolkit.
- Other areas of recommendations pertained to research priorities and public policy initiatives.
Work of the consensus conference will be continued through the American Society of Transplant (AST) with its collaborating societies.
Taken from a webinar presentation by Rebecca Hays, MSW, APSW (University of Wisconsin Hospital and Clinics). A special thanks to Rebecca for her contributions in this inservice.
Download Executive Summary from the Consensus Conference.
Editor: Hedi Aguiar RN, MSN, Director of Programs and Communications, The Alliance, firstname.lastname@example.org.
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LaPointe Rudow D, Hays R, Baliga P, et al. Consensus conference on best practices in live kidney donation: recommendations to optimize education, access, and care. Am J Transplant. 2015; 15(4): 914-22. doi: 10.1111/ajt.13173
Moore DR, Serur D, LaPointe Rudow D, et al. Improving efficiencies in live kidney donor evaluation – recommendations from a consensus conference. Clin J Am Soc Neph. 2015 (in press).
Rodrigue JR, LaPointe Rudow D, Hays R. Best practice in live kidney donation: consensus conference recommendations go beyond the transplant programs. Clin J Am Soc Neph. 2015 (in press).
Rodrigue JR, Kazley AS, Mandelbrot DA, et al. Overcoming disparities in living kidney donation in the US: recommendations from a consensus conference. Clin J Am Soc Neph. 2015, Apr 16 (epub ahead of print).
Tan JT, Gordon EJ, Dew MA, et al. Facilitating education about live kidney donation: recommendations from a consensus conference. Clin J Am Soc Neph. 2015, Apr 23 (epub ahead of print).
Tushla L, LaPointe Rudow D, Milton J, et al. Reducing financial barriers to live kidney donation: recommendations from a consensus conference. Clin J Am Soc Neph. 2015, May 22 (epub ahead of print).
Waterman AD, Morgievich M, Cohen DJ, et al. Improving education outside of transplant centers about live donor transplantation – recommendations from a consensus conference. Clin J Am Soc Neph. 2015, Jun 26 (epub ahead of print).