Supported Research

Lay Abstract

For many patients who live with kidney failure, the best treatment option is a kidney transplant from a living donor. A living donor transplant offers patients a longer and better quality of life at a fraction of the cost of dialysis. Each year, 2000 people in Canada are evaluated to become living kidney donors. The evaluation of donors is a complex process which involves over 50 medical tests. Unfortunately, the evaluation time often takes one year or longer and requires donors to make multiple trips to the hospital, often on different days and in different locations. This significantly impacts a donor’s family and work life, so much that many donors have described this as the worst part of donating. Many donors drop out of the evaluation, possibly because of the difficult process. In 2016, we surveyed 44 donors three months after donation. Some donor comments included: “Speed up the process”, “long time from start to finish”, and “more appointments on one day”. One donor stated, “I found out when I submitted parking receipts for reimbursement that I visited the hospital 15 times”. We worked with living donors and healthcare providers across St Joseph’s Healthcare Hamilton to implement a One-Day Living Donor Candidate Assessment Clinic, where most required tests and consults are completed in one day. The clinic began in March 2019, occurs monthly and evaluates four donors per month. The design of our clinic was inspired by a similar clinic in Northern Ireland, which was credited with increasing the number of living donor kidney transplants. Despite strong arguments for developing a one-day clinic, there are no other Canadian transplant programs offering this option. In speaking with transplant program leaders, research data are needed to justify investing resources into a one-day clinic. We plan to evaluate this program using process measures (e.g., amount of time the donor evaluation took) and outcome measures (e.g., costs and number of living donor kidney transplants completed). In developing these measures, we obtained input from 77 participants, including kidney transplant recipients, donor candidates, healthcare providers, and healthcare administrators. Study objectives: 1. To compare living kidney donor candidates at the one-day clinic, with contemporary candidates who did not participate in the one-day clinic and with historical candidates who were assessed before the clinic started. We will also compare donor candidates at St Joseph’s Healthcare Hamilton with donor candidates at the five other adult transplant programs in Ontario for the three years since the clinic started, using routinely collected administrative healthcare data. Outcomes are the 21 measures of processes and outcomes (e.g., total evaluation time). 2. To understand the experiences of donor candidates who attended the one-day clinic, and the experiences of healthcare staff who delivered care in the clinic. We will do this by interviewing people using a structured interview and analyzing their verbatim responses using established frameworks. We hypothesize that the average assessment time and time to donation will be shorter, and that recipients will spend less time on dialysis and will be more likely to receive a transplant without ever having to be treated by chronic dialysis. We hypothesize that donor candidates will describe positive experiences at the one-day clinic, and we will use information on negative experiences to further improve our processes.