Live Kidney Donor Consensus Conference Recommendations

Friday, October 3, 2014

In the rare ‘easy consensus’ of the transplant world, we can agree that live donor kidney transplantation is the best treatment option for most patients with late-stage CKD. Consequently, the declining rate of living kidney donation in the US has been confounding. In spite of this, novel strategies to remove barriers to living donation have neither been effectively disseminated nor widely implemented. To address these issues, a consensus conference was held June 5-6, 2014 to identify best practices and knowledge gaps pertaining to live donor kidney transplantation and living kidney donation. Initiated by the AST Living Donor Community of Practice, and built with the support of the AST Board (as well as other entities), the conference ultimately partnered 11 professional societies and 67 participants representing transplant professionals, patients, and other stakeholders. Individual workgroups (who prepared for months in advance,) discussed processes for living kidney donation education; efficiencies in process; disparities in living donation; and financial and systemic barriers. The clinical, policy, and research recommendations are outlined below:

Clinical recommendations:

• Adopt the philosophical approach that LDKT is the best option, with education integrated throughout disease progression and treatment process
• Develop a culture supporting the LKD program, including dedicated living donor personnel, a streamlined process, careful evaluation of medically complex donors, and participation in KPD (or referral)
• Implement an independent, national educational website for patients and the general public. Include a LKD Financial Toolkit.
• Develop a process to ensure that transplant, nephrology, and primary care attain competency in LDKT educational content and approaches
• Provide more culturally-tailored LDKT education
• Systematically review live donor metrics to measure efficiencies and improve quality

Policy recommendations:

• Actively pursue policies that achieve financial neutrality for living donors, within the framework of federal law
• Improve and clarify CMS auditing of current transplant education within dialysis centers
• Expand OPTN policy pertaining to required educational elements for potential living donors, to include the evolving evidence base of impact and risk donors (eg., ESRD risk, future pregnancy).

Research priorities:

• Examine effectiveness of strategies to optimize informed decision-making
• Evaluate impact of strategies to strengthen partnerships between community nephrology and transplant
• Evaluate QI initiatives to optimize the donor evaluation process and experience
• Examine strategies to reduce financial barriers

Recommendations were broad and far-reaching, with more detail here: Executive Summary.

Participants are to be commended for measurable dissemination efforts. We encourage all readers to participate, and to join the AST LDCOP.