Meeting the 7000 Kidney Challenge The University of Michigan Plan

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Meeting the 7000 Kidney ChallengeThe University
of Michigan Plan

• Jeff Punch
• Randy Sung
• Alan Leichtman
• Division of Transplantation
• University of Michigan

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• How did we grow the kidney transplant program?
• How are we going to further grow the program?

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Steps to grow the program

• Successfully advocated for inclusion of
  Transplantation in the institutional strategic
  plan
• Consultants brought in
• Costs identified for Medicare cost report
  (7,000,000 left on the table over 5 years)
• Overall value of transplantation calculated

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Transplant is more than just an operation
Transplant Event
Referral
List
Pre-transplant Events
Post-transplant Events
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Institutional Response

• Costs of Transplant related care transferred from
  MDs to the hospital cost center
• Investment in Transplantation
• Number of pre-transplant coordinators increased
  from 3 to 8
• Evals per year increased from 800 to 1200
• Agreement reached regarding future investment

Transplants
Resources
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University of Michigan Kidney Transplant Volume
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How are we going to do more?

• Paired donation
• Use our data to find ways to improve
• Dual Kidneys
• Increase DCD utilization

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Review our data
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Dual Kidneys

• 2208 of 13,307 kidneys recovered in the U.S. were
  discarded in 2005 (16.6)
• 107 of 463 kidneys recovered in Michigan were
  discarded in 2005 (23.1).

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Analysis of 2005 Michigan Kidney Discards (N107)
Age
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Analysis of 2005 Michigan Kidney Discards (N107)

• 56 Kidneys
• Biopsy 31
• Clinical 25
• 12 did not have a pair
• 44 potential pairs 22 potential transplants

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Dual Kidney Strategy

• Accept pairs of kidneys that no one wants
• Transplant one patient with two kidneys
• Decrease discards, increase transplants

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Increase DCD

• 27 DCD to date in DSA (12 of 227 total donors)
• ECMO assist
• Allows ICU withdrawal
• May decrease DGF
• May improve non-renal organ function

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Graft Outcome for DCD
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Thank you
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UNOS Policy

• 3.5.7 Double Kidney Allocation. Kidneys from
  adult donors must be offered singly unless the
  donor meets at least two of the following
  conditions and the OPO would not otherwise use
  the kidneys singly
• (i) Donor age greater than 60 years
• (ii) Estimated donor creatinine clearance
  less than 65 ml/min based upon serum creatinine
  upon admission
• (iii) Rising serum creatinine (greater than 2.5
  mg/dl) at time of retrieval
• (iv) History of medical disease in donor (defined
  as either longstanding hypertension or diabetes
  mellitus)
• Adverse donor kidney histology (defined as
  moderate to severe glomerulosclerosis (greater
  than 15 and less than 50).
• Kidneys offered for double kidney
  allocation will be allocated, first locally, then
  regionally, and then nationally, according to the
  sequence and point system described in Policies
  3.5.6 and 3.5.11.