1. Living Donor Kidney Transplantation 2020 Strategy Update Lisa Burnapp

2. July 2014: LDKT 2020

4. 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

5. 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)

6. 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 (12.3 – 21.6) 1142
Wales
Scotland 14.1
Northern Ireland 30.4
* NHSBT UK Strategy for LDKT, 6

7. 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

8. LDKT in the UK
1067
ODT, NHSBT November 2011 8

9. Ambitions for the Future
“To match world class performance in living donor kidney transplantation”

10. Projected Activity: LDKT 2020FY
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

11. How?
18pmp ?
26pmp

12. 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

13. 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

14. 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.

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

16. Measuring Success 16

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

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

19. How are we doing?

20. Projected Activity: LDKT 2020FY
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%

21. 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

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