P82
LIVING KIDNEY DONOR ATTRITION RATES: THE ‘HIDDEN COSTS’ OF
LIVING KIDNEY DONATION IN A SUPRA-REGIONAL KIDNEY TRANSPLANT
CENTRE
Salter T, Silas L, Hilton R
Renal Unit, Guy’s & St Thomas’ NHS Foundation Trust, London
BACKGROUND: Living donor kidney transplantation accounts for 97% of living donation
activity in the UK and for 34% of kidney transplants across both adult and paediatric
recipients. It has become the treatment of choice for many patients, offering significantly
better rates of patient and graft survival.
We set out to assess the proportion of potential kidney donors who did not proceed to
donation, to analyse the reasons why and the resources expended.
METHOD: We present observational data from a single centre. We retrospectively analysed
the medical records of potential living kidney donors excluded from donation between
January and December 2014. We looked at the reason for exclusion and the resources
expended.
RESULTS: 122 living donors successfully donated a kidney in 2014. During the same time
period, 114 potential living kidney donors were excluded from the process.
The majority of reasons for exclusion fell into four broad categories: medical reasons (43%),
identification of a better matched donor (19%), recipient no longer requiring a living donor
kidney transplant, due for example to stabilisation of function, receipt of deceased donor
kidney transplant, preferring a simultaneous kidney and pancreas transplant, recipient dying
or becoming unfit for transplantation (17%), and donor withdrawal (16%).
All of the potential living donors who were excluded from the programme had an initial
phone call or exchanged emails with the Clinical Nurse Specialist (CNS), whilst 81%
underwent preliminary tests (ABO type, HLA type, renal profile, mid stream urine and
virology screening). 49% continued to outpatient assessment with the CNS, and 35%
underwent further assessment (full blood count, liver function tests, fasting blood glucose,
chest and abdominal x-ray, flow cross-match, ECG, CT renal angiogram and GFR/EDTA
clearance). 33% attended at least one outpatient assessment with a Consultant Nephrologist.
13% required additional medical tests, 4% required psychological assessment, and 9%
warranted at least one external specialist referral (e.g. urology, cardiology, psychiatry). 12%
of the excluded potential living donors underwent outpatient clinic assessment by a
Consultant Transplant Surgeon, 4% underwent Independent Assessment, 4% attended a Pre
Assessment appointment and 3% were listed for surgery.
For each completed living kidney donation the cost to the unit is in excess of £4500 for out
patient assessments and diagnostic tests, 8.6 hours of face to face clinician time (6.2 hours
CNS; 2.4 hours Consultant), plus additional time in multi-disciplinary discussions.
CONCLUSION: For each completed living kidney donation, 1.9 potential donors must enter
the pathway and those who are ultimately excluded from donation require significant
investment of time and resources, increasingly so as the potential donor progresses through
the assessment pathway. These ‘hidden costs’ of living kidney donation are important factors
in planning a living kidney donor programme.