The Adoption of a One-Day Donor Assessment Model in a Living Kidney Donor Transplant Program: A Quality Improvement Project.

BACKGROUND

Survival of kidney transplants and their recipients is significantly better after living donor than after deceased donor transplantation. However, historically, Northern Ireland has had a low rate of living donor kidney transplantation. The length and complexity of donor evaluation has been one of the main factors contributing to this pattern.

STUDY

DESIGN

Quality improvement project.

SETTINGS &

PARTICIPANTS

All people in Northern Ireland expressing an interest in becoming a living kidney donor between 2010 and 2015.

QUALITY IMPROVEMENT INTERVENTION: Potential donors deemed to be suitable after a screening questionnaire attended a comprehensive 1-day evaluation including all investigations that had been previously been implemented across multiple clinical visits.

OUTCOME: Change in rate of living donor transplantation following the quality improvement intervention.

MEASUREMENTS: Demographic data and reasons for nondonation.

RESULTS

431 potential donors underwent a 1-day assessment, with 284 (66%) ultimately donating and 12 (3%) still active in the program. Of the 135 (31%) potential donors who did not donate, 48 were unsuitable due to medical or surgical issues, 2 became pregnant, and 18 withdrew. For 38 (9%) potential donors, intended recipients found an alternative living or deceased donor transplant. For 29 (6%) potential donors, the transplantation did not proceed because of recipient-related issues. The annual rate of living donor kidney transplantation in Northern Ireland increased from a mean of 4.3 per million population (pmp) between 2000 and 2009 to 32.6 pmp between 2011 and 2015.

LIMITATIONS: Single geographical region with a potentially unrepresentative population and health care organization. Retrospective observational study. Paucity of data from the preintervention period.

CONCLUSIONS

Following implementation of a 1-day assessment process, we observed a considerable and sustained increase in the rate of living donor kidney transplantation. Making donor evaluation easier holds promise to increase the number of living donor kidney transplants, potentially optimizing outcomes for both recipients and donors.