RTSM, March 2015 1

Living Donor Kidney Transplantation 2020

Strategy Update

Lisa Burnapp

RTSM, March 2015 2

July 2014: LDKT 2020

http://odt.nhs.uk/pdf/ldkt_2020_strategy.pdf

RTSM, March 2015 3Source: Transplant activity in the UK, 2013-2014, NHS Blood and Transplant

664

87

485

637

128

599634

159

702

609

200

858

611

288

961

624

335

1062

637

373

1046

652

436

1055

705

507

1101

780

540

1146

2004-2005 2005-2006 2006-2007 2007-2008 2008-2009 2009-2010 2010-2011 2011-2012 2012-2013 2013-2014

Year

0

200

400

600

800

1000

1200Nu

mbe

r

Living donors

DCD donors

DBD donors

Number of deceased and living donors in the UK, 1 April 2004 - 31 March 2014

RTSM, March 2015 4

Implementation (2012-14)

• Commissioning living donor kidney transplantation (LDKT)

• Improving Availability of LDKT Across the UK

• Donor Safety and Welfare

• Recipients of LDKT with Higher Immune Risk

17 Recommendations

RTSM, March 2015 5

Key Achievements 2010-14 Strategy

• 4,199 living donor transplants performed (18pmp)

• 253 patients matched with a compatible donor in the paired/pooled scheme

• 256 patients transplanted from non-directed altruistic donors

• 34 altruistic donor chains

• 12% increase in incompatible transplantation (2012)

RTSM, March 2015 6

Projected UK LD Activity*

FY 11/12 12/13 13/14 14/15 15/16 16/17

LD (n) 1050 1081 1112 1143 1174 1205

pmp 17.0 17.5 18.0 18.5 19.0 19.5

2012/13 Activity (pmp)

England 17.3 (12.3 – 21.6) 1142Wales 15.4Scotland 14.1Northern Ireland 30.4

* NHSBT UK Strategy for LDKT, 2010-2014

RTSM, March 2015 7

Living Kidney Donation: Options

Suitable directed donor

Deceased donor list

Paired donation

ABOi or HLAi

Transplant

No No

YesYes Yes

Transplant tourism

Altruistic donor Original source:Keith Rigg

Domino donor

RTSM, March 2015 8

348 346404

459503 526

562 595536 532 511

99 108

119

170

226279

244249

244 249249

2 6

15

32

50

53 7055

64 5537

2 3

5

10

18

4461

7592 88

894

1030

2755 50

74

3

12

1626 35 60 107

0

100

200

300

400

500

600

700

800

900

1000

1100

1200

2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013

Nu

mb

er

Altruistic donor

Paired exchange

ABO incompatible

HLA incompatible

Unrelated donor

Related donor

LDKT in the UK

1067

RTSM, March 2015 9

Ambitions for the Future

“To match world class performance in living

donor kidney transplantation”

http://odt.nhs.uk/pdf/ldkt_2020_strategy.pdf

RTSM, March 2015 10

Projected Activity: LDKT 2020

FY 14/15 15/16 16/17 17/18 18/19 19/20

LDs

(nos)

1143 1174 1205 1298 1422 1608

pmp 18.5 19.0 19.5 21.0 23.0 26.0

RTSM, March 2015 11

How?

2010-14 18pmp ? 26pmp

RTSM, March 2015 12

Gap Analysis

1. Lack of consistency and integration of LDKT commissioning models across all four UK countries

2. Shortfall in capacity and infrastructure to maximise LDKT activity and improve effectiveness of the NLDKSS

3. Lack of consistency in applying the principles of ‘transplant first’ across nephrology practice

4. Lack of consistent information to maximise donor safety and welfare in both the short and the long-term

5. UK-wide variance in clinical management of recipients at higher immune risk

RTSM, March 2015 13

Objectives: LDKT 2020

1. Increase LDKT activity; state of the art donor care

2. Embed principle of ‘transplant first’ and improve equity of access to LDKT

3. Ensure the National Living Donor Kidney Sharing Schemes (NLDKSS) are clinically and cost effective

RTSM, March 2015 14

Outcomes LDKT 2020

1. NHSBT, commissioners and all UK health departments will work together to ensure that there are no financial disincentives to support a fully integrated UK- wide LDKT programme.

2. NHSBT, commissioners and clinicians will ensure that appropriate infrastructure, systems and processes are in place to maximise the number of transplants achieved from all suitable living kidney donors.

3. NHSBT, clinicians, commissioners and other authorities will ensure that outcomes of LDKT are monitored and that information is accurately interpreted and utilised to support state of the art donor and recipient care.

4. NHSBT and clinicians will ensure that all suitable recipients have an opportunity to consider the option of LDKT before dialysis or to minimise waiting time if dialysis is unavoidable, regardless of where they live in the UK.

5. NHSBT, society and individuals will ensure that awareness of LDKT is effective across all sectors of society in all four UK countries.

RTSM, March 2015 15

NHSBT

Clinicians

UK Health Departments

Commissioners

Other authorities

Society and individuals

Patient representatives

Charities

Who?

RTSM, March 2015 16

Measuring Success

RTSM, March 2015 17

What?• Global benchmarking

• Effective commissioning across the UK

• Timely assessment and surgery

• Effectiveness of NLDKSS

• Standardisation of antibody incompatible transplantation

RTSM, March 2015 18

Implementation and OversightImplementation: Sub-group of NHSBT Kidney Advisory Group

- Chaired by Aisling Courtney

Oversight: TOT 2020 oversight group

- Chaired by Elisabeth Buggins

RTSM, March 2015 19

How are we doing?

RTSM, March 2015 20

Projected Activity: LDKT 2020

FY 14/15 15/16 16/17 17/18 18/19 19/20

LDs

(nos)

1143 1174 1205 1298 1422 1608

pmp 18.5 19.0 19.5 21.0 23.0 26.0

- 6%

RTSM, March 2015 21

Activity

• LD Activity 6% behind projected activity (946 v 1002)

– 96.5% kidney; 3.5% liver – Average LDTx: 91.5/month (projected 95/month)

– Altruistic donations +3% 2013 v 2014 (n=110)

– January NLDKSS run: 40 Txs. identified, > 50% non-proceeding

RTSM, March 2015 22

RTSM, March 2015 23

Acknowledgements

• Colleagues from

– NHSBT– Kidney Advisory Group– LDKT 2020 Strategy Implementation Group– Transplant and referring centres– NHS England

• Patient and donor associations/representatives