Living Donor Kidney Transplantation

Abstract

Living donor kidney transplantation (LDKT) offers better quality of life and clinical outcomes, including patient survival, compared with remaining on dialysis or receiving a deceased donor kidney transplant. Although LDKT education within transplant centers for both potential recipients and living donors is very important, outreach and education to kidney patients in settings other than transplant centers and to the general public is also critical to increase access to this highly beneficial treatment. In June 2014, the American Society of Transplantation's Live Donor Community of Practice, with the support of 10 additional sponsors, convened a consensus conference to determine best practices in LDKT, including a workgroup focused on developing a set of recommendations for optimizing outreach and LDKT education outside of transplant centers. Members of this workgroup performed a structured literature review, conducted teleconference meetings, and met in person at the 2-day conference. Their efforts resulted in consensus around the following recommendations. First, preemptive transplantation should be promoted through increased LDKT education by primary care physicians and community nephrologists. Second, dialysis providers should be trained to educate their own patients about LDKT and deceased donor kidney transplantation. Third, partnerships between community organizations, organ procurement organizations, religious organizations, and transplant centers should be fostered to support transplantation. Fourth, use of technology should be improved or expanded to better educate kidney patients and their support networks. Fifth, LDKT education and outreach should be improved for kidney patients in rural areas. Finally, a consensus-driven, evidencebased public message about LDKT should be developed. Discussion of the effect and potential for implementation around each recommendation is featured, particularly regarding reducing racial and socioeconomic disparities in access to LDKT. To accomplish these recommendations, the entire community of professionals and organizations serving kidney patients must work collaboratively toward ensuring accurate, comprehensive, and up-to-date LDKT education for all patients, thereby reducing barriers to LDKT access and increasing LDKT rates.

Cultural competency of a mobile, customized patient education tool for improving potential kidney transplant recipients’ knowledge and decision-making

“…The MTC app resulted in statistically and clinically significant increases in patient knowledge The need for effective educational interventions in patients with ESRD is crucial as patients must choose between dramatically different renal replacement therapy options, especially given the ongoing and profound disparities in access to transplantation [22][23][24][25]. Patients with reduced access to specialty care and health information (e.g.…”

Health Disparities in Kidney Transplantation for African Americans

“…Other programs led by Waterman et al [52, 53] based on the Transtheoretical Model of Behavior Change acknowledge AA dialysis and transplant patients’ psychological and practical barriers work with individual patients in dialysis and transplant centers over multiple time points to increase stages of readiness for LDKT and DDKT. These programs have shown initial success in reducing racial disparities in transplant access, such as increasing living donor inquiries among AA compared to CA dialysis patients.…”

Educating Prospective Kidney Transplant Recipients and Living Donors about Living Donation: Practical and Theoretical Recommendations for Increasing Living Donation Rates

“…A second, equally critical vein of LDKT education research regards the best ways to cost-effectively increase access to LDKT education for the hundreds of thousands CKD and ESRD patients and their family members and friends. Technology-based solutions may provide significant efficiencies [12••]. Yet, little research is available to demonstrate whether e-learning-, telehealth-, or telephone- based LDKT education programs are as effective as pro- grams that deliver education in person with a clinician or other educator.…”

“…A recent American Society of Transplantation (AST) Consensus Conference on Best Practices in Live Kidney Donation recognized living donation as the optimal treatment option for most patients with kidney disease, with recommendations that both patients and their potential living donors be comprehensively educated about the benefits and risks of living donation [11••, 12••]. Among the highest priority recommendations were to insure that comprehensive LDKT education was available to patients at all stages of CKD as well as to their potential living donors, that LDKT education occur multiple times for individuals across the stages of CKD progression, and that distinct efforts be made to increase access to LDKT education for potential recipients and donors identifying as racial/ethnic minorities [11••].…”