Live donor kidney transplantation. Situation analysis and roadmap

Area of Science:

• Nephrology and Transplant Surgery
• Organ Donation and Transplantation
• Public Health Policy

Background:

• Living donor kidney transplantation (LDKT) is the optimal treatment for end-stage renal disease, offering superior patient and graft survival rates.
• Despite a historical increase, LDKT in Spain has seen a continuous decline in recent years, prompting an investigation into underlying causes.
• Potential factors for the decrease include a perceived sufficiency of deceased donors, increased workload for transplant teams, and a more conservative approach to donor assessment.

Purpose of the Study:

• To identify the causes for the decrease in living donor kidney transplantation (LDKT) in Spain.
• To analyze the relationship between LDKT rates and various stages of the donation process.
• To develop recommendations for optimizing the Spanish LDKT program.

Main Methods:

• A working group, including transplant teams and representatives from national transplant organizations and societies, was formed in 2018.
• A self-evaluation survey was developed and administered to 33 LDKT teams across Spain, covering all phases of the LDKT process.
• Analysis of survey responses led to a national SWOT (Strengths, Weaknesses, Opportunities, Threats) analysis and the formulation of targeted recommendations.

Main Results:

• The study identified significant variability in LDKT rates among different transplant centers and regions, independent of deceased donor rates.
• The analysis highlighted specific strengths, weaknesses, opportunities, and threats within the Spanish LDKT program.
• The findings underscore that the decline in LDKT is influenced by factors beyond the availability of deceased donors.

Conclusions:

• The decrease in LDKT in Spain is multifactorial and requires targeted interventions at various stages of the donation process.
• The developed recommendations aim to address identified weaknesses and enhance the overall efficiency and effectiveness of the LDKT program.
• The report and its recommendations have been reviewed by experts, adopted by regional authorities, and submitted for public consultation, indicating broad consensus and institutional support.