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Live donor kidney transplantation. Situation analysis and roadmap
María de la Oliva Valentín1, Domingo Hernández2, Marta Crespo3
1Organización Nacional de Trasplantes, Madrid, Spain.
Nefrologia
|September 26, 2022
Summary
Living donor kidney transplantation (LDKT) in Spain has declined despite increased deceased donors. A national assessment identified key areas for improvement in the LDKT process to optimize outcomes.
Area of Science:
- Nephrology and Transplant Surgery
- Organ Donation and Transplantation
Background:
- Living donor kidney transplantation (LDKT) is the optimal treatment for end-stage renal disease, offering superior patient and graft survival.
- Despite continuous growth from 2005-2014, LDKT rates in Spain have decreased in recent years.
- Potential factors for this decline include increased deceased donor transplants and a perceived sufficiency of organ supply.
Purpose of the Study:
- To identify the underlying causes for the decline in living donor kidney transplantation (LDKT) in Spain.
- To analyze the LDKT process across different phases and identify areas for optimization.
- To develop targeted recommendations for improving LDKT rates and outcomes nationwide.
Main Methods:
- A national working group, including transplant teams and representatives from key nephrology and transplant societies (SENTRA, SET, ONT), was formed.
- A self-evaluation survey was distributed to 33 LDKT centers, covering all stages of the donation process: information, donor work-up, informed consent, surgeries, follow-up, and human resources.
- Analysis of survey responses led to a national SWOT analysis and the development of specific recommendations.
Main Results:
- The study identified significant variability in LDKT rates among Spanish transplant centers and regions, independent of deceased donor rates.
- The analysis revealed specific strengths, weaknesses, opportunities, and threats within the Spanish LDKT program.
- A comprehensive report, 'Spanish living donor kidney transplant program assessment: recommendations for optimization,' was developed based on these findings.
Conclusions:
- The decrease in LDKT in Spain is influenced by factors beyond the availability of deceased donors.
- The developed recommendations, reviewed by experts and adopted institutionally, aim to optimize every step of the living donor kidney transplantation process.
- Implementing these recommendations is crucial for revitalizing LDKT programs and improving long-term transplant outcomes.
Keywords:
Autoevaluación del proceso de donación de vivoBenchmarkingChronic kidney disease treatmentEvolución donación de vivoLiving donation evolutionLiving donation processLiving donor kidney transplantationOptimización de la donación de vivoOptimization of living kidney donationProceso de donación de vivoSelf-assessment of the living donation processTrasplante renal de donante vivoTratamiento de la enfermedad renal crónica avanzada
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