Telemedicine for Evaluation and Counseling of Living Kidney Donor Candidates

项目总结

PROJECT SUMMARY Nearly 100,000 patients with kidney failure in the US await kidney transplantation. Living donation reduces the wait and offers superior survival compared with deceased donation. Yet only 6,000 living kidney donations are achieved every year with a substantial decline in donation among biologically related donors in across race/ethnicity. While prior programs were associated with a 6-fold increase in donor referral, efforts to convert donor candidates to donor nephrectomy have been largely unsuccessful. Access to a transplant center is a key barrier to engagement of donor candidates. Alas, the pandemic has amplified this existing barrier. Living kidney donor evaluation is a complex multiphase process that includes activities over approximately one year. We have previously reported that two-thirds of referred persons are deemed medically ineligible donors after reviewing medical history and/or laboratory screening results. Of the one-third who are deemed eligible donor candidates, only 54% complete donor evaluation and counseling (of whom 58% ultimately donate), whereas 35% cannot proceed to complete this initial outpatient clinic visit due to non-medical (personal, social, and arrangement) reasons. The initial outpatient clinic visit is thus a bottleneck as it involves the first obligatory trip to an in-person visit where access to a transplant center becomes a barrier for willing candidates facing geographic, financial, or logistics challenges to come for their initial in-person evaluations. Efforts to promote engagement of kidney donor candidates are needed. Telemedicine via synchronous video visits can facilitate coordination of care in the donor evaluation process. Donor evaluation may become more accessible, efficient, and convenient. The rapid adoption of telemedicine during the pandemic has created opportunities and challenges. In our national survey of US transplant centers, we found that 81% reported telemedicine challenges related to structure and processes of care. In primary care studies, telemedicine video visits have achieved high levels of patient satisfaction and similar outcomes compared to in-person visits. A knowledge gap exists regarding how donor candidates perceive telemedicine in care coordination, and how to best tailor telemedicine care coordination in donor evaluation. Our scientifically goal is to integrate a telemedicine care coordination intervention into the donor evaluation process to enhance engagement of donor candidates and support completion of their evaluation. This award will allow Dr. Al Ammary the protected time to complete his proposed research. Findings of this work will fill a knowledge gap about the new paradigm using telemedicine for donor evaluation and offer preliminary data for an R01-funded randomized clinical trial to test the effectiveness of telemedicine care coordination in increasing living donation and support his transition to independence.