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

摘要 肾移植的需求继续大大超过供应，活着的肾脏捐赠者仍然存在 是他们所爱的人的重要器官来源。活体供肾移植(LDKT)在#年有所减少 美国自2004年以来，重要的是，LDKT的可能性一直存在显著的地理差异 确定，美国东南部的失业率最低。移植候选者相关和潜在的生活 与捐赠者有关的因素，包括难以要求家人/朋友代表自己捐献以及缺乏知识 关于捐赠过程，分别与较低的捐赠率有关。计划一直是 开发的目的是将倡导角色与移植候选人分开，以克服障碍 与要求某人代表自己捐献有关，并表现出在世捐赠者数量的增加 问询。重要的是，这些计划是在资源密集型城市环境中开发和实施的 这使得人们可以随时接入高速互联网、手机服务，而且地理位置靠近城市- 以移植中心为基础，将它们的普适性限制在像美国东南部农村这样的低资源环境中。 此外，这些计划没有包括有针对性的干预措施，以改善潜在的活体捐赠者对 评价进程，阻碍了LDKT的持续增长。活体捐赠者的选择是一项全面的 从潜在捐赠者询问开始的过程，筛选潜在捐赠者的绝对禁忌症 捐赠(例如，孤立肾脏)、评估，并最终获得批准。这个过程很耗时， 势不可挡，涉及到与医疗保健系统复杂而频繁的交互。不足为奇的是， 许多潜在的在世捐赠者在批准和捐赠之前退出了这一进程。多项研究表明 演示了患者导航器计划在改善结果方面的可行性和有效性，包括 有效利用医疗保健系统。为了解决现有计划中的知识差距，旨在 为了增加活体捐献，我们利用RE-AIM框架开发并实现了一种新的活体捐赠者 导航员计划(LDN)。LDN将宣传培训结合起来，以克服发起对话的障碍 使用非临床导航器引导捐赠者通过 评估过程。早期结果表明，在LDN中获得批准的捐赠者的可能性增加了7倍 参与者与非参与者的比较；然而，对LDN覆盖范围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计划的扩展是为了 包括远程医疗提供将克服获取机会的地理差异，并促进 活体捐赠。为此，我们将解决以下目标：1)进行定性评估，以确定 参与LDN远程保健的促进者，2)实施LDN远程保健计划，以及3)比较 远程保健LDN模式与护理标准对增加活体肾脏捐赠的有效性。

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.