Project Overview

Many patients with kidney failure will live longer and healthier lives if they receive a kidney transplant rather than dialysis. Unfortunately, there are too few deceased donors to meet the demand, and most patients wait years for a transplant. Some die while waiting. It is safe for a healthy adult to donate one of their kidneys to a patient with kidney failure. However, in Canada, only one-third of kidney transplants are from living donors.

Living donor kidney transplantation offers many advantages over deceased donor transplantation, including superior rates of graft and patient survival, shorter wait times, and lower health care costs. For these reasons, Canada is looking for ways to safely increase rates of living donor kidney transplantation.

By increasing awareness and breaking down barriers related to living kidney donation, the Living Donor Kidney Transplantation project aims to ensure that more patients with advanced kidney disease receive the best form of treatment available.

“Living kidney donation, as the gold standard of care, needs to be more accessible for all patients, regardless of age, gender, ethnicity, geography or income. Many patients aren’t aware of the benefits of receiving a living donor kidney over dialysis or deceased kidney transplant. This has to change. This research team, which includes patients and living donors, is breaking down barriers that patients and donors currently face while trying to receive a transplant, with the end goal of increasing living kidney donation rates and ultimately, save many more lives.” -Sue McKenzie, Patient partner and recipient of a living donor kidney

Can-SOLVE CKD Phase 1: Increasing the use of living donor kidney transplantation

Phase 1 Project Video

Theme 1: Improving the Efficiency of the Living Donor Candidate Evaluation

To improve the efficiency of the living donor candidate evaluation, we did the following:

  • Analyzed the evaluation process for living donor candidates in 15+ transplant centres in Canada.
  • Surveyed living kidney donors, transplant recipients, healthcare providers, and administrators, and identified measures that transplant centres can use to monitor and improve the living donor evaluation processes.
  • Analyzed the cost-effectiveness of evaluating multiple donor candidates simultaneously.

Major Findings

  • Average time until donation is 10.3 months.
  • Identified 20 measures that could improve the living kidney donor evaluation process.
  • Benefits to evaluating multiple living donor candidates simultaneously:
    • Cost savings of $5000 per recipient
    • Shortened evaluation time by one month.
  • A living donor transplant that occurs 3 months earlier results in:
    • Higher transplant rates
    • Lower healthcare costs
    • Shorter time on dialysis.

Theme 1 resulted in several peer-reviewed manuscripts, with patients as co-authors.

Theme 2: Quality improvement intervention to improve access to kidney transplantation and living donation

In collaboration with living kidney donors, kidney transplant recipients, healthcare professionals, researchers and two provincial health system organizations (Ontario Renal Network and Trillium Gift of Life Network, both part of Ontario Health) the goal of Theme 2 was to increase the number of steps potentially transplant-eligible patients with advanced chronic kidney disease complete towards kidney transplant, including:

  • Referral to a transplant centre for an evaluation
  • Living donor contacting a transplant centre for an evaluation
  • Being added to the deceased donor waitlist
  • Receiving a transplant from a living or deceased donor

To achieve this, we developed the Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD) trial. A pragmatic, cluster-randomized clinical trial developed to determine if a quality improvement intervention provided in chronic kidney disease (CKD) programs helps potentially transplant-eligible patients with advanced CKD to complete key steps toward receiving a kidney transplant.

The EnAKT LKD trial:

  • Twenty-six participating CKD programs and 6 adult transplant centres across Ontario, caring for >20,000 patients.
  • The CKD programs were randomly assigned to either usual care (13 CKD programs) or the multi-component quality improvement strategy (13 CKD programs)
  • The multi-component quality improvement strategy included four components:
    • Administrative support to establish local teams to drive performance
    • Transplant educational resources
    • An initiative for transplant recipients and living donors to share stories and experiences (Transplant Ambassadors Program [TAP])
    • Program-level performance reports and oversight by administrative leaders.
  • Trial period: November 1, 2017, to December 31, 2021 (trial completed)
  • Full trial results will be publicly available in the coming months.

Phase 1 Publications

Can-SOLVE CKD Phase 2: Mobilizing Research Findings to Achieve More Living Donor Kidney Transplants

Our team is currently implementing Phase 2 of this project, where we will mobilize our Phase 1 research findings to achieve more living donor kidney transplants in Canada.

Specifically, in Can-SOLVE CKD Phase 2 we will:

  • Develop benchmarks for an efficient living donor kidney evaluation (e.g., how long it should take for candidates to learn if they are eligible to donate).
  • Translate metrics for an efficient living donor kidney evaluation into scorecards to track how well programs are meeting targets.
  • Translate the results of our process evaluation evaluating our quality improvement intervention to help more eligible patients in Ontario receive a kidney transplant.
  • Test and evaluate solutions to improve the efficiency of living donor kidney evaluations (e.g., the one-day donor evaluation clinic currently running at St. Joseph’s Healthcare Hamilton).

Our team is currently in the early phases of the project. We anticipate all objectives will be completed by 2026.

Click to view full size poster

Our Patient Partners have been integral to the success and implementation of this project.

During the project, they have:

  • Identified the research topics as a priority.
  • Helped formulate the questions.
  • Helped conduct the studies and interpret the results.
  • Developed and implemented TAP.
  • Developed the National Patient Partner Coalition, subcommittee of the Kidney Patient and Donor Alliance Canada
  • Developed videos where they tell their own stories.

Contact

If you are interested in more information about this project, please contact Kyla.Naylor@lhsc.on.ca.

Phase 1 publications

Efficiency of the living kidney donor evaluation:

Quality improvement intervention to improve access to kidney transplantation and living donation

Living Donor Kidney Transplantation

Project lead(s):

Drs. Seychelle Yohanna, Kyla Naylor and Amit Garg

Patient lead(s):

Susan McKenzie

Research theme(s):

Transplantation

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