Enhanced Advocacy and Health Systems Training Through Patient Navigation Increases Access to Living-donor Kidney Transplantation

Abstract

Background. To date, no living donation program has simultaneously addressed the needs of both transplant candidates and living donors by separating the advocacy role from the candidate and improving potential donor comfort with the evaluation process. We hypothesized that the development of a novel program designed to promote both advocacy and systems training among transplant candidates and their potential living kidney donors would result in sustained increases in living-donor kidney transplantation (LDKT). To this end, we developed and implemented a Living Donor Navigator (LDN) Program at the University of Alabama at Birmingham. Methods. We included adult patients awaiting kidney-only transplant in a retrospective cohort analysis. Using time-varying Cox proportional hazards regression, we explored likelihood of living donor screening and approval by participation in the LDN program. Results. There were 56 LDN participants and 1948 nonparticipants (standard of care). LDN was associated with a 9-fold increased likelihood of living donor screenings (adjusted hazard ratio, 9.27; 95% confidence interval, 5.97-14.41, P < 0.001) and a 7-fold increased likelihood of having an approved living donor (adjusted hazard ratio, 7.74; 95% confidence interval, 3.54-16.93; P < 0.001) compared with the standard of care. Analyses by participant race demonstrated higher likelihood of screened donors and a similar likelihood of having an approved donor among African Americans compared with Caucasians. Conclusions. These data suggest that both advocacy and systems training are needed to increase actual LDKT rates, and that LDN programs may mitigate existing racial disparities in access to LDKT.

A Qualitative Assessment of the Living Donor Navigator Program to Identify Core Competencies and Promising Practices for Implementation

“…20 Our focus group guide included 3 of these levels of evaluation, with the Results level assessed in a retrospective cohort study described elsewhere. 17 Participants were asked about the navigator program content and delivery (Reaction), knowledge and comfort gained through the program (Learning), and how they applied the information gained in the sessions (Behavior). All focus group sessions were audio-recorded, facilitated, and transcribed by the first author.…”

“…The navigator program has proven efficacious at increasing living donor screenings, approvals and living donor kidney transplants. 17 Despite this early success, we lack understanding of what recruitment techniques and approaches are most effective, and as such, the navigator program may not have reached its full adoption. Therefore, the purpose of this study was to discover areas of strength and potential improvement for the navigator program and subsequently to identify Core Competencies for training navigators and advocates.…”

Impact of Social Vulnerability on Access to Educational Programming Designed to Enhance Living Donation

“…As a result, several programs have been developed to increase access to living donor transplantation. 11–13 Programs such as the Johns Hopkins Live Donor Champion and the Mount Sinai Kidney Coach Program provide advocacy training to transplant candidates and their champions/coaches and have demonstrated increases in donor inquires and screenings. 12,13 Additionally, the Living Donor Navigator (LDN) program, developed by the University of Alabama at Birmingham, which simultaneously addresses the needs of transplant candidates and potential donors by combining advocacy and systems training has also been associated with increases in potential donor screenings and donor approval.…”

The Living Donor Navigator Program Provides Support Tools for Caregivers

“…1 –3 These programs, including the Living Donor Navigator (LDN) program, have demonstrated increased access to living donor kidney transplantation. 4 Patients who enroll in the LDN program are encouraged to identify a family member or friend to serve as their advocate and attend 4 educational sessions at our institution, where they learn about living donor transplantation, utilize role playing exercises and social media to tell their loved one’s story, and interact with prior living donors and their recipients. The goal of the LDN program is for our non-clinical lay navigators to provide the transplant candidate and their advocate with tools to assist them in successfully identifying a potential living kidney donor.…”

“…Analyses of the multi-level approach of the LDN program revealed an increased likelihood of both donor screening and approval for patients who participated in the program compared to standard care. 4 Previous qualitative analyses conducted among participants of the LDN program identified 4 main themes associated with program content, delivery, and participation (communication, education, support, and commitment) and have informed program refinement and further exploration of the types of advocates best served by the program. 5…”