Living Donor Kidney Transplantation 2020 Strategy Update Lisa Burnapp

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Living Donor Kidney Transplantation 2020
Strategy Update Lisa Burnapp
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July 2014 LDKT 2020
http//odt.nhs.uk/pdf/ldkt_2020_strategy.pdf
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Implementation (2012-14)

• Commissioning living donor kidney transplantation
  (LDKT)
• Improving Availability of LDKT Across the UK
• Donor Safety and Welfare
• Recipients of LDKT with Higher Immune Risk
• 17 Recommendations

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Key Achievements 2010-14 Strategy

• 4,199 living donor transplants performed (18pmp)
• 253 patients matched with a compatible donor in
  the paired/pooled scheme
• 256 patients transplanted from non-directed
  altruistic donors
• 34 altruistic donor chains
• 12 increase in incompatible transplantation
  (2012)

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Projected UK LD Activity
FY 11/12 12/13 13/14 14/15 15/16 16/17
LD (n) 1050 1081 1112 1143 1174 1205
pmp 17.0 17.5 18.0 18.5 19.0 19.5
2012/13 Activity (pmp) England 17.3 (12.3
21.6) 1142 Wales 15.4 Scotland 14.1 Nor
thern Ireland 30.4
NHSBT UK Strategy for LDKT, 2010-2014
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Living Kidney Donation Options
Transplant tourism
Paired donation
Suitable directed donor
Deceased donor list
No
No
ABOi or HLAi
Yes
Yes
Yes
Transplant
Domino donor
Altruistic donor
Original sourceKeith Rigg
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LDKT in the UK
1067
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Ambitions for the Future

• To match world class performance in living donor
  kidney transplantation

http//odt.nhs.uk/pdf/ldkt_2020_strategy.pdf
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Projected Activity LDKT 2020
FY 14/15 15/16 16/17 17/18 18/19 19/20
LDs (nos) 1143 1174 1205 1298 1422 1608
pmp 18.5 19.0 19.5 21.0 23.0 26.0
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How?
2010-14
18pmp
?
26pmp
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Gap Analysis

• Lack of consistency and integration of LDKT
  commissioning models across all four UK countries
• Shortfall in capacity and infrastructure to
  maximise LDKT activity and improve effectiveness
  of the NLDKSS
• Lack of consistency in applying the principles of
  transplant first across nephrology practice
• Lack of consistent information to maximise donor
  safety and welfare in both the short and the
  long-term
• UK-wide variance in clinical management of
  recipients at higher immune risk

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Objectives LDKT 2020

• Increase LDKT activity state of the art donor
  care
• Embed principle of transplant first and improve
  equity of access to LDKT
• Ensure the National Living Donor Kidney Sharing
  Schemes (NLDKSS) are clinically and cost
  effective

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Outcomes LDKT 2020
NHSBT, commissioners and all UK health departments will work together to ensure that there are no financial disincentives to support a fully integrated UK- wide LDKT programme.
NHSBT, commissioners and clinicians will ensure that appropriate infrastructure, systems and processes are in place to maximise the number of transplants achieved from all suitable living kidney donors.
NHSBT, clinicians, commissioners and other authorities will ensure that outcomes of LDKT are monitored and that information is accurately interpreted and utilised to support state of the art donor and recipient care.
NHSBT and clinicians will ensure that all suitable recipients have an opportunity to consider the option of LDKT before dialysis or to minimise waiting time if dialysis is unavoidable, regardless of where they live in the UK.
NHSBT, society and individuals will ensure that awareness of LDKT is effective across all sectors of society in all four UK countries.
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Who?
NHSBT Clinicians
Society and individuals Patient
representatives Charities
UK Health Departments Commissioners Other
authorities
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Measuring Success
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What?

• Global benchmarking
• Effective commissioning across the UK
• Timely assessment and surgery
• Effectiveness of NLDKSS
• Standardisation of antibody incompatible
  transplantation

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Implementation and Oversight

• Implementation
• Sub-group of NHSBT Kidney Advisory Group
• Chaired by Aisling Courtney
• Oversight
• TOT 2020 oversight group
• - Chaired by Elisabeth Buggins

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How are we doing?
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Projected Activity LDKT 2020
FY 14/15 15/16 16/17 17/18 18/19 19/20
LDs (nos) 1143 1174 1205 1298 1422 1608
pmp 18.5 19.0 19.5 21.0 23.0 26.0
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Activity

• LD Activity 6 behind projected activity (946 v
  1002)
• 96.5 kidney 3.5 liver
• Average LDTx 91.5/month (projected 95/month)
• Altruistic donations 3 2013 v 2014 (n110)
• January NLDKSS run 40 Txs. identified, gt 50
  non-proceeding

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Acknowledgements

• Colleagues from
• NHSBT
• Kidney Advisory Group
• LDKT 2020 Strategy Implementation Group
• Transplant and referring centres
• NHS England
• Patient and donor associations/representatives