How Our kidney waitlist is over 5000, our liver waitlist is to - - PDF document

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How to Increase Living Donation John P. Roberts M.D. Disclosure

• Past Consultant for Medsleuth

UCSF Living Donor Program

• The living donor institute (kidney and liver)

has a dedicated staff of 6 RNs, 1 NPs, and 6 AAs

• Our kidney waitlist is over 5000, our liver waitlist is
• ver 700
• In CY 2017 we performed:

‐ 236 deceased donor kidney transplants ‐ 111 living donor kidney transplants ‐ 156 deceased donor liver transplants ‐ 30 living donor liver transplants

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Survival of Leukemia Pancreatic Cancer Survival

WorkFlow

• Recipient candidate evaluation and listing
• Living donor candidate evaluation
• Recipient Phase 2 evaluation
• Donation/Transplantation
• Living Donor follow up
• Recipient follow up

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Living Donor Evaluation Process Old Way

• Recipients seen at evaluation, given paper HHQ for

donor or HHQ mailed to donor then mailed back.

• HHQ reviewed by RN and many patients immediately

eliminated for BMI, diabetes, stones or hypertension.

• Onsite Donor workup 1 (labs, urine, BPs, CXR, EKG, HLA

testing)

• Results review by RN/MD
• Next step was DWU2 (Nephrologist, SW/ILDA, CTA) at

UCSF

• Selection
• Surgery

Pain Points

• Paper forms

– Dog ate my homework

• Many of the health issues on the forms resulted in

donor disqualifications, e.g. Hypertension, diabetes, could have been eliminated quickly.

• Patients had to travel to UCSF for labs and other testing

– Appointments cancelled, no shows – Labs resulted in patients being ruled out which wasted patient and center time.

• Patients needed to return for CT scan.

Why do we need NEW solutions?

• Manage a high volume of patients (5000+

recipients, 1000+ potential donors).

• Cut down on use of paper, which is costly to

mail, hard to track, inefficient and time consuming for patients, donors and centers.

• Reduce barriers for donors.
• Increase workflow efficiency for transplant

center staff.

• Decrease the time between evaluation and

transplant

• Allow for more transplants.

The Patient and the Internet

• Disease/condition specific searches
• Health care products (drugs, devices, health care plans)
• Wellness/complementary or alternative medicine
• User created content websites (blogs etc)
• Quality ranking/patient reviews for doctors/hospitals

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Electronic Donor IntAKE

• Developed web based intake tool
• Up front questions about common rule out causes

but nuanced; BMI cutoffs, single drug hypertension, gestational diabetes.

• Donors passed up front screen then went to in‐depth

questionnaire with questions about medications, fitness, job status, etc.

• HHQ created as PDF and then reviewed by nurse or

physician to formulate further questions and alternate workups

• eHHQ

Completion of Remote Screening

Reasons for Screen Out Smoking, BMI>35, HTN, Drugs Kidney Stones Diabetes

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Advantages of eHHQ

• Decrease friction for donors to get

information about donation and apply online.

• Link to website can be ubiquitous.
• Recipients can email potential donors with

explanation of why they need a donor and include link.

• Draft email for recipients to send to potential

donors

eLab testing

• Barrier to donation is initial lab testing if the patient

needed to come to UCSF

• Local Blood/urine testing at LabCorp.
• Paid for by UCSF at LabCorp.
• Patients sent map to local lab.
• Patients who don’t get labs done are given 2 email

reminders and phone call.

• Patients who can’t go to local lab for testing aren’t viable

donor candidates

• Liver donors only have ABO done as eLab as this is the

most common reason for rule out in patients who pass HHQ.

eLab Testing

• Use of local LabCorp lab at UCSF expense.
• Patient can go to lab close to home

– 66% of those who pass screening get blood work done – Allows for screening out of donors who don’t go to lab (34%). – Eliminates center visits for lab failures – Result in UCSF EHR electronically

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Who Gets Labs Done?

• Younger less likely than older.

– Social Media effect?

• Spouse more likely than child
• Related twice more likely than unrelated
• Frequency of exercise related

After eLab

• Results reviewed on‐line at UCSF and

decisions made about donor suitability.

• Based on ABO testing, donor and recipient

ages and HLA testing, decisions made about potential exchange candidates.

• Patients with strong possibility of donation

come to UCSF for social work, physician/NP and surgeon visits, and radiologic testing.

Technologies Used in Donor Evaluation

‐ eHHQ ‐ eLabCorp/Litholink ‐Walgreens, ‐ EHRs and Interfaces

Living donor Follow‐up

• Send secure email with personalized web link.
• Patients complete clinical data at website
• Patient go to LabCorp to get creatinine and
• urinalysis. Provides local LabCorp address.
• UCSF pays for LabCorp costs.
• LabCorp data appears in UCSF EMR
• Phone call for those who don’t complete

clinical data or lab visit.

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Thanks

• Claus Niemann
• Anna Mello
• Carolyn Light
• Chris Freise
• Living donor liver and kidney teams.