Mapping the living kidney donor assessment pathway
The mapping the living kidney donor (LKD) assessment pathway project is supported by The Health Foundation and brings together partners from the UK Kidney Association, NHS Blood and Transplant, clinicians, individuals with donation experience, and CSH. The project is being delivered in two phases.
Why is Mapping the Living Kidney Donor Assessment Pathway Project important?
In 2019, there were 3,483 kidney transplants in the UK, including 1,042 from living donors. Most patients wait around two years for a transplant, during which time they typically require dialysis; only 8-9% received a pre-emptive transplant.
Living donor transplants can expand access – especially for minority ethnic groups – but the current donor pathway is inconsistent, time consuming, and involves multiple appointments.
Redesigning this pathway with input from staff and donors could improve equity, increase pre-emptive transplants, and reduce time on dialysis – lowering both environmental and health impacts. At the same time, dialysis is a key carbon hotspot, and the donor process itself could be made more sustainable.
Phase 1
An initial three-month project was undertaken to map the LKD assessment pathway, identify variations, estimate its environmental impact, and highlight sources of inequity. With guidance from the UKLKD Network, three services were selected to reflect diverse settings (e.g. urban vs rural, transplant vs non transplant centres).
Key findings:
- The average carbon footprint of a LKD assessment pathway (excluding surgery) is 114 kgCO2e.
- Experience of donors is key.
- Any reduced carbon model needs to be balanced with the needs of the donors.
- If pathways are too inflexible, donor drop off/experience potentially outweighs the carbon benefits.
- Getting more donors onto and through the pathway means more donations and less dialysis – better for patients and good for the environment.
Phase 2
Building on from phase 1, phase 2 is all about disseminating learning and supporting services to evaluate their LKD assessment pathway and implement findings and changes from phase1. Implementation support will focus on:
Toolkit and carbon footprint measurement tool
Providing a toolkit to support LKD services to review and evaluate their LKD assessment pathway, along with a measurement tool to help them estimate the environmental impact of their pathway before and after any changes. Implementation support will focus on:
Step by step guidance to help you conduct pathway analysis in your own service.
An Excel-based calculator designed to help you measure the carbon footprint of your LKD assessment pathway, identify key carbon hotspots, and reassess your emissions after implementing changes.
Online workshops and drop in sessions
Online workshops to support local teams to review their pathway, using the toolkit. Providing the opportunity to network with peers and share valuable learning.
Sign up to workshops:
Workshop 1: Overview of tools
Workshop 2: ?
Workshop 3: ?
Regional-system pilot
Additional learning will be generated through a regional system pilot. This will involve deeper engagement with LKD services and the wider systems and organisations they operate within across a regional network. The pilot will explore barriers, enablers, and outcomes related to implementing change at a regional level.
Please contact Dr Frances Mortimer, CSH’s clinical director, for more information.