Living Donation & Transplantation

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Presentation transcript:

Living Donation & Transplantation

National Trends Deceased donors recovered increased by 9.8%, and deceased donor organs transplanted increased by 10.7% from 2015 increases in ECD, DCD, SCD donors DCD donors now comprise 17% of deceased donors overall (ranges from 10%-25% by region) 0.4% decrease in living donation from 2015-2016.

Waiting List Additions 2007-2016 U.S.

Waiting List Registrations 2007-2016 Region 8

Deceased and Living Donors 2007-2016 U.S. Increase in deceased donor transplants over the last 3 years, whereas living donor transplants have stagnated or even declined.

Deceased and Living Donors 2007-2016 U.S. Living donation appears to be more prevalent in some regions than others. 40% or more of all donors are living donors in Region 1, 7, 9, and 10. While in Regions 3 and 11, less than 30% of donors are living donors. Region 8 671 deceased donors, 326 living donors (33%)

Deceased and Living Donors 2007-2016 Region 8

Pediatric Living Donor Kidney Transplants 2007-2016 Region 8 and Nation

Region 8 Living Donors, 2014-2016 2014 2015 2016 LD kidney: 293 LD liver: 13 LD liver: 12 LD liver: 18

Focus Areas to ↑ access to Living Donor Transplantation Education & Outreach Transplant candidates – before end-stage organ failure Potential donors Education Apps, Social media tools, Brochures UNOS ‘Kidney Learning Center’ (goal: December 2017) Logistics & Efficiency of Evaluation Electronic intake Early / multiple potential donor evaluations? Live Donor Champions fits under first bullet – Candidate education/advocacy Education Apps: iChoose Kidney, My Transplant Coach ‘Facebook App’ K Lentine, March 2017

Focus Areas to ↑ access to Living Donor Transplantation Mitigating Economic Barriers NLDAC – Travel & lodging grants; ‘wage coverage’ pilot AST ‘Financial Toolkit’ Improving Safety & Defensibility of Donor Selection ESRD risk projection calculator www.transplantmodels.com/esrdrisk APOL1 genotyping – NIH ‘APOLLO’ consortia New KDIGO Living Donor Guideline (2017) SRTR ‘Living Donor Collective’ (registry) K Lentine, March 2017

Discussion Barriers to increasing living donation nationally and within the region Ideas for maximizing living donation Best practices Use of living donor ESRD risk projection calculator www.transplantmodels.com/esrdrisk Recent literature focuses on negative aspects of living donation Social networking Education, education, education Other region discussion points: Increased sharing best practices of successful interventions to increase living donation Living donor champions Scripting of living donor discussion (Who is your living donor, not do you have one) Referring nephrologists encouraging living donation early in course of CKD (education to referring nephrologists?) Finances of living donation- ethic committee white paper (Financial Incentives in Organ Donation- suspended from this public comment period). All financial concerns not well understood/ researched Living donor committee pamphlet for recipients regarding living donation Flexibility in scheduling living donor evaluation- after hours/ weekends? Conflicting information about long term health consequences of living donation (high risk/ minority population)