Telemedicine for Evaluation and Counseling of Living Kidney Donor Candidates

PROJECT SUMMARY
Nearly 100,000 patients with kidney failure in the US await kidney transplantation. Living donation reduces the
wait and offers superior survival compared with deceased donation. Yet only 6,000 living kidney donations are
achieved every year with a substantial decline in donation among biologically related donors in across
race/ethnicity. While prior programs were associated with a 6-fold increase in donor referral, efforts to convert
donor candidates to donor nephrectomy have been largely unsuccessful. Access to a transplant center is a key
barrier to engagement of donor candidates. Alas, the pandemic has amplified this existing barrier.
Living kidney donor evaluation is a complex multiphase process that includes activities over approximately one
year. We have previously reported that two-thirds of referred persons are deemed medically ineligible donors
after reviewing medical history and/or laboratory screening results. Of the one-third who are deemed eligible
donor candidates, only 54% complete donor evaluation and counseling (of whom 58% ultimately donate),
whereas 35% cannot proceed to complete this initial outpatient clinic visit due to non-medical (personal, social,
and arrangement) reasons. The initial outpatient clinic visit is thus a bottleneck as it involves the first obligatory
trip to an in-person visit where access to a transplant center becomes a barrier for willing candidates facing
geographic, financial, or logistics challenges to come for their initial in-person evaluations. Efforts to promote
engagement of kidney donor candidates are needed. Telemedicine via synchronous video visits can facilitate
coordination of care in the donor evaluation process. Donor evaluation may become more accessible, efficient,
and convenient. The rapid adoption of telemedicine during the pandemic has created opportunities and
challenges. In our national survey of US transplant centers, we found that 81% reported telemedicine
challenges related to structure and processes of care. In primary care studies, telemedicine video visits have
achieved high levels of patient satisfaction and similar outcomes compared to in-person visits. A knowledge
gap exists regarding how donor candidates perceive telemedicine in care coordination, and how to best tailor
telemedicine care coordination in donor evaluation.
Our scientifically goal is to integrate a telemedicine care coordination intervention into the donor evaluation
process to enhance engagement of donor candidates and support completion of their evaluation. This award
will allow Dr. Al Ammary the protected time to complete his proposed research. Findings of this work will fill a
knowledge gap about the new paradigm using telemedicine for donor evaluation and offer preliminary data for
an R01-funded randomized clinical trial to test the effectiveness of telemedicine care coordination in increasing
living donation and support his transition to independence.

Grant Number: 5K23DK129820-06
NIH Institute/Center: NIH
Principal Investigator: Fawaz Al Ammary