Mapping the living kidney donor assessment pathway
The mapping the living kidney donor (LKD) assessment pathway project was supported by The Health Foundation and brought together partners from the UK Kidney Association, NHS Blood and Transplant, Give a Kidney, clinicians, individuals with donation experience, and CSH. The project was 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
Phase 2 focused on applying learnings from Phase 1 in practice, aiming to disseminate findings through the development and implementation of practical tools. This phase also explored how local and regional collaboration could enable change through a regional pilot.
Toolkit and carbon footprint measurement tool
A toolkit and Excel based carbon calculator were developed to support LKD services to evaluate their pathways through mapping and carbon footprint estimation. These tools are designed to be practical and open-access tools for transplant teams to utilise.
Step by step guidance to help you conduct pathway analysis in your own service.
An Excel-based calculator designed to help teams measure the carbon footprint of their LKD core assessment pathway, identify key carbon hotspots, and reassess their emissions after implementing changes.
National dissemination and engagement
A strong emphasis was placed on national dissemination of Phase 1 findings and early learning from Phase 2. Findings were shared through a programme of regional and national events, alongside two national online webinars introducing the toolkit and carbon calculator.
Regional-system pilot
A regional system pilot was carried out to apply learnings from Phase 1 in greater depth, building deeper engagement with LKD services and the wider systems they operate within. The pilot brought together five referring and two transplant centres across the Yorkshire and Humber region to explore how regional collaboration could enable change.
Workshops
CSH facilitated four online workshops, bringing together clinicians, operational staff, and donor coordinators across the region to:
- Test the toolkit and carbon footprint measurement tool using actual pathway data
- Identify variation across sites through pathway comparison
- Establish shared priorities for improvement, with potential for local and regional action
Pilot outcomes
Through this process, key changes with potential to increase clinical efficiency and reduce financial costs were identified. The pilot not only allowed the learning from Phase 1 to be applied in detail but also facilitated peer learning and regional collaboration. It provided valuable learning around moving from insight to practical prioritisation of change, establishing that the most actionable improvements exists at local and regional levels.
“The whole project was incredibly stimulating for the group in Yorkshire. It really brought some important patient care and system issues to the fore. I also think that it’s continuing to have a ripple effect in my own area of Yorkshire.”
– Dr Matthew Wellberry Smith, Consultant Renal Transplant Physician, Leeds Teaching Hospitals NHS Trust
Key learnings
The project has provided a practical foundation for future action. Key learnings include:
- Regional collaboration is a highly valuable way of working, facilitating change through enablement of peer learning, direct comparison between services, and practical prioritisation of change
- Local change is the most actionable
- Tools enable change through supporting discussion and analysis, but must be used alongside clinical judgment
- Engagement can be supported by framing sustainability and equity as part of quality improvement
- Sustained improvement can be constrained by capacity, requiring the correct conditions, relationships, structures and support in order to action meaningful change
Final Report
For further detail about this project, and to learn about its impact and outcomes, read the final report.
Please contact Dr Frances Mortimer, CSH’s clinical director, for more information.