P146
‘ANOTHER FEATHER IN OUR CAP’- DEVELOPING A TRANSPLANT CO-ORDINATION
ROLE WITHIN THE KIDNEY FAILURE SUPPORT TEAM IN A NON-TRANSPLANTING
RENAL UNIT
Dodds, A, Richardson, C, Barrett, M, Ferris, B
Kidney Failure Support Team, Heart of England NHS Foundation (Teaching) Trust
PROBLEM: Kidney transplantation discussion, work-up, referral and the management of patients
active on the transplant list has historically been a very lengthy, haphazard and un-coordinated
process within non-transplanting renal units where no dedicated transplant co-ordinators exists.
PURPOSE: The need for a transplant co-ordination role was identified in our centre and it was
decided that this role would be split between the four team members of the Kidney Failure Support
Team (KFST) whose main role to date was the education, preparation and management of the predialysis population.
DESIGN: Each team member was given the responsibility of managing the transplant work-up,
referral process and patients active on the transplant list for a dialysis unit and a case load of predialysis patients with designated time each week to perform these roles/duties. Co-ordinators attend
monthly multi-disciplinary team meetings at dialysis units to identify transplant status on all patients,
monitoring progress with all patients undergoing transplant work-up and ensuring that all patients
active on the transplant list are fit and have up-to date investigations. Stronger links with the
Transplanting Centres and the Trust’s Living Donor Transplant Coordinator have been developed
with regular meetings and communications via e-mail using nhs.net accounts. A database has been
developed and maintained. The referral process has become more regulated through the KFST, and
patients are now referred with the reports of all relevant investigations. Each co-ordinator is now
supported by a link worker from each dialysis unit. The role of the link workers is clearly defined and
two study days have so far been held to educate them with regard to these new roles and to improve
the overall kidney transplantation knowledge of the link workers and KFST co-ordinators.
FINDINGS: In the past 6 months since the start of this new transplantation co-ordination role, a
significant improvement in the identification of transplant status of all patients has been noted. The
pre-dialysis population has improved from 35% to 87% of the patient cohort now having a transplant
status. The dialysis population has improved from 71% to 89% having a status. The role has also
enabled us to identify and focus on patients requiring transplantation work up at the pre dialysis stage.
A comparison of patients activated on the list prior to and following the KFST involvement showed a
significant improvement in length of time from commencement of work-up to activation on the list,
from an average of 13.8 months to 3.8 months.
CONCLUSION: The development of transplant co-ordination role within our Trust has had a major
impact on the ESRF patient’s journey towards transplantation. It has ensured a more efficient process
from work up to referral to the transplant centre, resulting in patients being activated on the transplant
list much more quickly and efficiently.
Relevance: As stated in the Renal National Service Framework “a successful kidney transplant is the
most clinically and cost effective treatment for many patients with end stage renal failure.” The workup and referral process is pivotal in ensuring that patients get the opportunity for a transplant so it is
essential that this is performed in a timely and robust manner. We are well on our way to ensuring this
is the case within our centre with this newly formed role within the KFST team.