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Health System-Level Barriers to Living Donor Kidney Transplantation

Dr. Shaifali Sandal
The Research Institute of the McGill University Health Centre
Kidney Health Research Grant
2021 - 2023

General Audience Summary

Background: Living donor kidney transplantation (LDKT) is the best treatment option for patients with kidney failure. But even though we know this, the number of patients getting LDKT in Canada has not risen in the last ten years. There are also very different rates of LDKT in different provinces. We don’t know why this is. When researchers have tried to help increase rates of LDKT, they have usually tried to do this by focusing on individual people, such as patients. They have suggested teaching patients more about LDKT, for example. But focusing on individual people ignores how complicated healthcare is and how many different people and places are involved in LDKT. In Canada, there are no national guidelines for LDKT and each province has a different way of organizing things when it comes to LDKT.

Methods: We think that differences in how provinces organize LDKT may help to explain why rates are so different across Canada. So, we want to know more about what provinces are doing differently to help understand why some have higher amounts of LDKT than others, and how they do it. To do this we will conduct something called a ‘comparative case study’. This means that we will learn and compare how three different provinces, which have high, medium, and low rates of LDKT, do things when it comes to LDKT. We will learn about all the people and places involved in LDKT in these three provinces, by talking to people, watching what they do, and reading documents, like policies, that they follow. Then we will compare how these provinces do things to understand what helps to provide LDKT and what makes it harder.

Relevance: By doing this study, we hope that we can make suggestions for how Canadian provinces can help boost their rates of LDKT. Other studies of LDKT have tended to look at individual parts of a healthcare system – our study is the first one that will look at all of the different people and places involved, and how they are connected. By doing this, we hope that we can make suggestions for improvements that are grounded in how healthcare operates in real life. Overall, we want to help promote LDKT in Canada, because it is the treatment option for kidney failure that benefits patients the most.