Living Donor Kidney Transplantation 2020 Strategy Update Lisa Burnapp

July 2014: LDKT 2020 http://odt.nhs.uk/pdf/ldkt_2020_strategy.pdf

Implementation (2012-14) 17 Recommendations Commissioning living donor kidney transplantation (LDKT) Improving Availability of LDKT Across the UK Donor Safety and Welfare Recipients of LDKT with Higher Immune Risk 17 Recommendations

Key Achievements 2010-14 Strategy 4,199 living donor transplants performed (18pmp) 253 patients matched with a compatible donor in the paired/pooled scheme 256 patients transplanted from non-directed altruistic donors 34 altruistic donor chains 12% increase in incompatible transplantation (2012)

Projected UK LD Activity* FY 11/12 12/13 13/14 14/15 15/16 16/17 LD (n) 1050 1081 1112 1143 1174 1205 pmp 17.0 17.5 18.0 18.5 19.0 19.5 2012/13 Activity (pmp) England 17.3 (12.3 – 21.6) 1142 Wales 15.4 Scotland 14.1 Northern Ireland 30.4 * NHSBT UK Strategy for LDKT, 2010-2014 6

Living Kidney Donation: Options Transplant tourism Paired donation Suitable directed donor Deceased donor list No No ABOi or HLAi Yes Yes Yes Transplant Domino donor Altruistic donor Original source:Keith Rigg 7 7

LDKT in the UK 1067 ODT, NHSBT November 2011 8

Ambitions for the Future “To match world class performance in living donor kidney transplantation” http://odt.nhs.uk/pdf/ldkt_2020_strategy.pdf

Projected Activity: LDKT 2020 FY 14/15 15/16 16/17 17/18 18/19 19/20 LDs (nos) 1143 1174 1205 1298 1422 1608 pmp 18.5 19.0 19.5 21.0 23.0 26.0

How? 2010-14 18pmp ? 26pmp

Gap Analysis Lack of consistency and integration of LDKT commissioning models across all four UK countries Shortfall in capacity and infrastructure to maximise LDKT activity and improve effectiveness of the NLDKSS Lack of consistency in applying the principles of ‘transplant first’ across nephrology practice Lack of consistent information to maximise donor safety and welfare in both the short and the long-term UK-wide variance in clinical management of recipients at higher immune risk

Objectives: LDKT 2020 Increase LDKT activity; state of the art donor care Embed principle of ‘transplant first’ and improve equity of access to LDKT Ensure the National Living Donor Kidney Sharing Schemes (NLDKSS) are clinically and cost effective 13

Outcomes LDKT 2020 NHSBT, commissioners and all UK health departments will work together to ensure that there are no financial disincentives to support a fully integrated UK- wide LDKT programme. NHSBT, commissioners and clinicians will ensure that appropriate infrastructure, systems and processes are in place to maximise the number of transplants achieved from all suitable living kidney donors. NHSBT, clinicians, commissioners and other authorities will ensure that outcomes of LDKT are monitored and that information is accurately interpreted and utilised to support state of the art donor and recipient care. NHSBT and clinicians will ensure that all suitable recipients have an opportunity to consider the option of LDKT before dialysis or to minimise waiting time if dialysis is unavoidable, regardless of where they live in the UK. NHSBT, society and individuals will ensure that awareness of LDKT is effective across all sectors of society in all four UK countries.

Who? NHSBT Clinicians Society and individuals UK Health Departments Patient representatives Charities UK Health Departments Commissioners Other authorities

Measuring Success 16

What? Global benchmarking Effective commissioning across the UK Timely assessment and surgery Effectiveness of NLDKSS Standardisation of antibody incompatible transplantation

Implementation and Oversight Sub-group of NHSBT Kidney Advisory Group Chaired by Aisling Courtney Oversight: TOT 2020 oversight group - Chaired by Elisabeth Buggins

How are we doing?

Projected Activity: LDKT 2020 FY 14/15 15/16 16/17 17/18 18/19 19/20 LDs (nos) 1143 1174 1205 1298 1422 1608 pmp 18.5 19.0 19.5 21.0 23.0 26.0 - 6%

Activity LD Activity 6% behind projected activity (946 v 1002) 96.5% kidney; 3.5% liver Average LDTx: 91.5/month (projected 95/month) Altruistic donations +3% 2013 v 2014 (n=110) January NLDKSS run: 40 Txs. identified, > 50% non-proceeding

Acknowledgements Colleagues from NHSBT Kidney Advisory Group LDKT 2020 Strategy Implementation Group Transplant and referring centres NHS England Patient and donor associations/representatives