Promoting Increases in Living Organ Donation via Tele-navigation (PILOT)

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SUMMARY The demand for kidney transplantation continues to greatly exceed the supply, and living kidney donors remain a critical source of organs for their loved ones. Living donor kidney transplantation (LDKT) has decreased in the US since 2004, and importantly, significant geographic disparities in likelihood of LDKT have been identified, with the southeastern US having the lowest rates. Transplant candidate-related and potential living donor-related factors, including difficulty asking family/friends to donate on one’s behalf and lack of knowledge about the donation process, respectively, have been implicated in lower donation rates. Programs have been developed to separate the advocacy role from the transplant candidate in order to overcome barriers associated with asking someone to donate on one’s behalf, and have demonstrated increases in living donor inquiries. Importantly, these programs were developed and implemented in resource-intense urban settings that afforded ready access to high-speed internet, cell phone service and close geographic proximity to urban- based transplant centers, limiting their generalizability to low-resource settings like the rural, southeastern US. Moreover, these programs failed to include targeted interventions to improve potential living donor comfort with the evaluation process, impeding sustained increases in LDKT. Living donor selection is a comprehensive process that begins with potential donor inquiry, screening of potential donors for absolute contraindications to donation (e.g. solitary kidney), evaluation, and ultimately approval. This process is time-consuming, overwhelming, and involves complex and frequent interactions with the healthcare system. Not surprisingly, many potential living donors withdraw from the process prior to approval and donation. Multiple studies have demonstrated the feasibility and efficacy of patient navigator programs in improving outcomes, including more efficient use of healthcare systems. In order to address knowledge gaps within existing programs designed to increase living donation, we utilized the RE-AIM framework to develop and implement a novel Living Donor Navigator Program (LDN). LDN combines advocacy-training to overcome barriers in initiating conversations with and identification of potential living donors with the use of non-clinical navigators to guide donors through the evaluation process. Early results indicate a 7-fold increase in likelihood of an approved donor among LDN participants compared to non-participants; however, assessment of LDN reach and adoption demonstrated that geographic disparities among participants exist. We hypothesize that expansion of the LDN program to include telehealth delivery will overcome geographic disparities in access and facilitate sustained increases in living donation. To this end, we will address the following aims: 1) Conduct qualitative assessments to identify facilitators for LDN telehealth participation, 2) Implement a LDN telehealth program, and 3) Compare the effectiveness of telehealth LDN model vs. standard of care for increasing living kidney donation.