17 March 2016 Aisling Courtney Projected Activity LDKT 2020 1415 1516 1617 1718 1819 1920 LDT nos 1143 1223 1260 1368 1512 1728 pmp 185 190 195 210 230 260 LDKT 2020 adjusted to population projections ID: 635962
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Slide1
Living donation review
Renal Transplant Services Meeting
17 March 2016
Aisling CourtneySlide2
Projected Activity: LDKT 2020
14/15
15/16
16/1717/1818/1919/20LDT nos*114312231260136815121728pmp18.519.019.521.023.026.0
* LDKT 2020, adjusted to population projections
1092
2014/15 Activity by UK Country (
pmp
)
Overall UK 15.9
England 15.6 (Range 12.0 – 19.2)
Wales 14.3
Scotland 14.3
Northern Ireland
30.4Slide3Slide4Slide5
Strategy implementation group workstreams
Commissioning
Donor safety & welfare
Higher immune riskAccess & availabilitySlide6
Where do we start?
Self-assessment
Survey
Comparative dataNHSBT centre specific data on LD TxSlide7
Survey
(
self-assessment)
Survey monkey 15 questionsInvitation by emailOne reminder emailTransplant centresLead surgeon Lead nephrologistLiving donor co-ordinatorReferring unitsLead nephrologist +/- co-ordinatorResponse: >1 from each transplant centre 69% of referring unitsSlide8
Demographics
Transplant centres
Population served
Many centres uncertainDialysis populationMost did not knowTransplant centres50% Transplant first25% Dialysis first25% Equivocal PhilosophySlide9
LD limitation
In our centre LD transplant activity is primarily limited by:
Number of potential donors volunteering
Number who, after completing some or all investigations, are considered unsuitableBed/nursing capacityLack of resources to provide a timely work-upTheatre accessSurgical resourcesH&I resourcesOther (free text)Slide10
Number volunteering
Transplant centres
50% unanimous response yes, primary limitation
33% variable response17% not a limitationReasonDemography 50%Patient education 40%Differing priorities 30%OtherReferring units75% said primary limitationReason (some skipped)Demography 35%Patient education 20%Differing priorities 5%Slide11
Percentage unsuitable
Transplant centres
Referring units
40%35%Skipped by 3 unitsSlide12
Work-up time
Transplant centres
Referring units
35%Skipped by 4 units40%Slide13
Resources
Assessment
30% limited by resources
Surgical40% limitedNumber of surgeonsCompeting demands for surgeonsDays per week for LD Tx1 day in 45%4 or 5 day in 20%Slide14
Other
Kidney Sharing Scheme
60% positive
NegativeToo few actually transplantedInflexible infrastructure (in own or another centre)Donor reluctanceFinal questionsThe best aspect of our LD programme, that might be beneficial to share with other centres, is:The single greatest barrier to increasing LD transplantation in our centre is:Slide15
NHSBT data
(peer assessment)Slide16
Where do we start?
Self-assessment
Survey
Comparative dataNHSBT centre specific data on LD TxWhat do we do next?Slide17
Developing 2020 vision
Who?
nnnn nnnnnn nnnn
What?Where?When?Why?Some of implementation groupDissemination of dataTx meetings / auditsSoon(ish)Because no one centre has all the answersSlide18
Proposal
Regional data
Survey
NHSBT2020 target for centre / regionHow do we get there?Challenging recipientChallenging donorProcessPatient & public educationThe way forwardSlide19
Number of living kidney transplants in 2014 by transplant centre Slide20
Proportion of kidney transplants (DBD, DCD, Living) in 2014 by centreSlide21
Number volunteering
EducationSlide22
Are all considered unsuitable really unsuitable?
Is there a way to confirm this?
2nd opinion never
sought (two units), or rarely (one unit)UnsuitableSlide23
Proportion of pre-emptive living kidney transplants in 2014, by centre
Excludes 64 patients who have unknown dialysis status at transplantSlide24
Transplant first?Slide25
Kidney Sharing SchemeSlide26
Number of pairs
registered to dateSlide27
Proportion of type of compatibility of pairs registered to dateSlide28
Number of
paired patients transplanted to dateSlide29
Proportion of registered paired patients that have received a transplant through the scheme to dateSlide30
NDADs in 2014
by centre
In total,
110 NDADsSlide31
Incompatible living
donor transplants
by centre in 2014 Slide32
Proposal
Regional data
Survey
NHSBT2020 target for centre / regionHow do we get there?Challenging recipientChallenging donorProcessPatient & public educationThe way forwardSlide33
Projected Activity: LDKT 2020
14/15
15/16
16/1717/1818/1919/20LDT nos*114312231260136815121728pmp18.519.019.521.023.026.0
* LDKT 2020, adjusted to population projections
1092
2014/15 Activity by UK Country (
pmp
)
Overall UK 15.9
England 15.6 (Range 12.0 – 19.2)
Wales 14.3
Scotland 14.3
Northern Ireland
30.4Slide34
NI living donor numbers
32.7
pmp
pa4.7 pmp paSlide35
Laboratory alert – 12 hour post-transplant specimen