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

总结 肾移植的需求继续大大超过供应，活体供肾者仍然存在。 为他们所爱的人提供重要的器官来源。活体供肾移植（LDKT）在2010年有所下降。 美国自2004年以来，重要的是，LDKT的可能性存在显著的地理差异， 美国东南部的发病率最低。移植候选人相关和潜在的生活 与捐赠者有关的因素，包括难以让家人/朋友代表自己捐赠以及缺乏知识 关于捐赠过程，分别与较低的捐赠率有关。方案已经 将倡导角色与移植候选人分开，以克服障碍 与要求某人代表某人捐赠有关，并且已经证明活体捐赠者的增加 询问。重要的是，这些方案是在资源密集型城市环境中制定和实施的 提供高速互联网和手机服务，地理位置靠近城市- 基于移植中心，限制他们的普遍性低资源设置，如农村，美国东南部。 此外，这些计划未能包括有针对性的干预措施，以改善潜在的活体捐赠者的舒适度， 评估进程，阻碍了LDKT的持续增长。活体捐赠者的选择是一个全面的 这个过程从潜在的捐赠者询问开始，筛选潜在的捐赠者的绝对禁忌症， 捐赠（例如，孤立肾）、评估和最终批准。这个过程很耗时， 压倒性的，涉及与医疗保健系统的复杂和频繁的互动。毫不奇怪， 许多潜在的活体捐赠者在批准和捐赠之前退出该过程。多项研究 证明了患者导航程序在改善结果方面的可行性和有效性，包括更多 有效利用医疗保健系统。为了解决现有方案中的知识差距， 为了增加活体捐赠，我们利用RE-AIM框架开发和实施了一种新的活体捐赠者 导航程序（LDN）。LDN结合了沟通培训，以克服发起对话的障碍 通过使用非临床导航仪指导供体， 评估过程。早期结果表明，在LDN中获得批准的供体的可能性增加了7倍 参与者与非参与者相比;然而，对土地退化零增长覆盖率和采用率的评估表明， 参与者之间存在地域差异。我们假设LDN计划的扩展， 包括提供远程保健服务，将克服在获得服务方面地域差异，并促进 活体捐赠为此，我们将实现以下目标：1）进行定性评估，以确定 LDN远程医疗参与的促进者，2）实施LDN远程医疗计划，以及3）比较 远程医疗LDN模式与标准护理对增加活体肾脏捐献的有效性。

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.