Care of international living kidney donor candidates in the United States: A survey of contemporary experience, practice, and challenges

Abstract

The evaluation and care of non-US citizen, non-US residents who wish to come to the United States to serve as international living kidney donors (ILKDs) can pose unique challenges. We surveyed US transplant programs to better understand practices related to ILKD care. We distributed the survey by email and professional society listservs (Fall 2018, assessing 2017 experience). Eighty-five programs responded (36.8% program response rate), of which 80 considered ILKD candidates. Only 18 programs had written protocols for ILKD evaluation. Programs had a median of 3 (range: 0,75) ILKD candidates who initiated contact during the year, from origin countries spanning 6 continents. Fewer (median: 1, range: 0,25) were approved for donation. Programreported reasons for not completing ILKD evaluations included visa barriers (58.6%), inability to complete evaluation (34.3%), concerns regarding follow-up (31.4%) or other healthcare access (28.6%), and financial impacts (21.4%). Programs that did not evaluate ILKDs reported similar concerns. Staff time required to evaluate ILKDs was estimated as 1.5-to-3-times (47.9%) or >3-times (32.9%) that needed for domestic candidates. Among programs accepting ILKDs, on average 55% reported successful completion of 1-year follow-up. ILKD evaluation is a resource-intensive process with variable outcomes. Planning and commitment are necessary to care for this unique candidate group.

Survey of current transplant center practices regarding COVID-19 vaccine mandates in the United States

“…dates. 4,5 The proportion of respondents without a vaccine mandate citing "Other" and the accompanying free-text responses (Tables S3 and S4) suggest that discussions around instituting a mandate policy remain fluid in many transplant programs, with some programs No: The vaccine mandate applies equally to adult and all pediatric candidates (defined as age <18) 4 (10) No: The vaccine mandate applies to adult and pediatric candidates, but is limited to pediatric candidates for whom the COVID−19 vaccine is approved under EUA or full FDA approval 5 (12) Yes: The vaccine mandate applies to adult candidates, but pediatric candidates (defined as age<18) are excluded from the mandate 11…”

“…Representative responses from centers with multiple respondents were selected using a hierarchical algorithm, prioritizing responses from transplant surgeons, transplant physicians, and other providers, similar to previous methods. 9 , 10 , 11 , 12 , 13 For centers with more than one response from a respondent in the same role at the same transplant center, after the above two steps, we retained the earliest submitted survey (Figure S1 ). The volume of transplant practice represented by responding centers was computed by center‐level linkages to Scientific Registry of Transplant Recipients (SRTR) data.…”

Pancreas transplantation perceptions and practice: Results from a national US survey

“…Respondents were identified by online outreach to US transplant professionals, and not all centers are represented. However, the response rate of 42% (56/134) is similar or higher than many contemporary studies of transplant program practices 27–30 . A majority (59%) of all pancreas transplant volume is represented by the responding programs in this survey.…”

“…13,14,26 Oversight of the pancreas transplant community has been chal- However, the response rate of 42% (56/134) is similar or higher than many contemporary studies of transplant program practices. [27][28][29][30] A majority (59%) of all pancreas transplant volume is represented by the responding programs in this survey. Most responders were transplant surgeons; however, arguably, the most pressing challenges in the field surround acute donor and recipient selection decisions that come from transplant surgeons.…”

Deceased Donor Procurement Biopsy Practices, Interpretation, and Histology-Based Decision-Making: A Survey of US Kidney Transplant Centers

“…For programs with multiple respondents participating in offer evaluation, we selected a single participant to represent the program using a hierarchical algorithm that prioritized responses from surgeons, followed by nephrologists and then other staff, similar to previous methods. 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 In the case of multiple responses after that prioritization, we selected the earliest submitted questionnaire. All responses and responses by role were evaluated in secondary analyses.…”