1. Living donation review Renal Transplant Services Meeting 17 March 2016 Aisling Courtney

2. Projected Activity: LDKT 2020 14/1515/1616/1717/1818/1919/20 LDT nos*114312231260136815121728 pmp18.519.019.521.023.026.0 * LDKT 2020, adjusted to population projections 1092 2014/15 Activity by UK Country (pmp) Overall UK15.9 England15.6 (Range 12.0 – 19.2) Wales14.3 Scotland14.3 Northern Ireland 30.4

5. Strategy implementation group workstreams Commissioning Donor safety & welfare Higher immune risk Access & availability

6. Where do we start? Self-assessment – Survey Comparative data – NHSBT centre specific data on LD Tx

7. Survey (self-assessment) Survey monkey – 15 questions Invitation by email One reminder email Transplant centres – Lead surgeon – Lead nephrologist – Living donor co-ordinator Referring units – Lead nephrologist +/- co-ordinator Response: >1 from each transplant centre 69% of referring units

8. Demographics Transplant centres Population served – Many centres uncertain Dialysis population – Most did not know Transplant centres 50% Transplant first 25% Dialysis first 25% Equivocal Philosophy

9. 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 unsuitable – Bed/nursing capacity – Lack of resources to provide a timely work-up – Theatre access – Surgical resources – H&I resources – Other (free text)

10. Number volunteering Transplant centres 50% unanimous response yes, primary limitation 33% variable response 17% not a limitation Reason Demography 50% Patient education 40% Differing priorities 30% Other Referring units 75% said primary limitation Reason (some skipped) Demography 35% Patient education 20% Differing priorities 5%

11. Percentage unsuitable Transplant centresReferring units 40% 35% Skipped by 3 units

12. Work-up time Transplant centresReferring units 35% Skipped by 4 units 40%

13. Resources Assessment 30% limited by resources Surgical 40% limited – Number of surgeons – Competing demands for surgeons Days per week for LD Tx – 1 day in 45% – 4 or 5 day in 20%

14. Other Kidney Sharing Scheme 60% positive Negative Too few actually transplanted Inflexible infrastructure (in own or another centre) Donor reluctance Final questions The 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:

15. NHSBT data (peer assessment)

16. Where do we start? Self-assessment – Survey Comparative data – NHSBT centre specific data on LD Tx What do we do next?

17. Developing 2020 vision Who? nnnn nnnnnn nnnn What? Where? When? Why? Some of implementation group Dissemination of data Tx meetings / audits Soon(ish) Because no one centre has all the answers

18. Proposal Regional data – Survey – NHSBT 2020 target for centre / region How do we get there? – Challenging recipient – Challenging donor – Process – Patient & public education The way forward

19. Number of living kidney transplants in 2014 by transplant centre

20. Proportion of kidney transplants (DBD, DCD, Living) in 2014 by centre

21. Number volunteering Education

22. Are all considered unsuitable really unsuitable? Is there a way to confirm this? 2nd opinion never sought (two units), or rarely (one unit) Unsuitable

23. Proportion of pre-emptive living kidney transplants in 2014, by centre Excludes 64 patients who have unknown dialysis status at transplant

24. Transplant first?

25. Kidney Sharing Scheme

26. Number of pairs registered to date

27. Proportion of type of compatibility of pairs registered to date

28. Number of paired patients transplanted to date

29. Proportion of registered paired patients that have received a transplant through the scheme to date

30. NDADs in 2014 by centre In total, 110 NDADs

31. Incompatible living donor transplants by centre in 2014

32. Proposal Regional data – Survey – NHSBT 2020 target for centre / region How do we get there? – Challenging recipient – Challenging donor – Process – Patient & public education The way forward

33. Projected Activity: LDKT 2020 14/1515/1616/1717/1818/1919/20 LDT nos*114312231260136815121728 pmp18.519.019.521.023.026.0 * LDKT 2020, adjusted to population projections 1092 2014/15 Activity by UK Country (pmp) Overall UK15.9 England15.6 (Range 12.0 – 19.2) Wales14.3 Scotland14.3 Northern Ireland 30.4

34. NI living donor numbers 32.7 pmp pa 4.7 pmp pa

35. Laboratory alert – 12 hour post-transplant specimen