Microsoft



March 2018

UK Living Kidney Sharing Schemes: Quarterly Update

Dear Colleagues,

Welcome to the quarterly update for the UK Living Kidney Sharing Schemes. As always, thanks to Matthew Robb and Chloe Brown for providing the key performance statistics (appendix 1), which include activity and outcomes up to the October 2017 matching run.

Thank you for your support in implementing the key changes that were introduced in January and highlighted in the November bulletin- in particular, the requirement to include all non-directed altruistic donors (NDADs) in the UKLKSS, which resulted in an all-time high in the number of NDADs registered in a single matching run.

From this update, the key messages from the October 2017 matching run are:

• Increase in the number of transplants identified in a single matching run (n= 78)- the highest ever

• Increase in the proportion (57%) of proceeding transplants

• 35% of identified transplants did not proceed at all

• 8% were severely delayed (> 3/12) after the matching run

• Only 25% of non-directed altruistic donors donated into an altruistic donor chain (option to choose removed from January 2018)

With the new survey monkey reporting system, the reasons for non-proceeding transplants will be identified more accurately in future bulletins and should decrease.

FOR CONSULTATION: Donor complexity and information sharing

Following the October 2017 workshop, a fixed time working group (FTWG) met in January to make recommendations on:

1. Registering donor complexity in the UKLKSS

2. A minimum data set for sharing donor-recipient information between centres

Please find the consultation document attached (appendix 2). I am grateful to my colleagues of the FTWG for their contribution to a productive meeting and input into the final draft.

There are two sections to the document, reflecting the recommendations for 1 and 2 above.

Please return any comments or feedback on the consultation document to lisa.burnapp@nhsbt.nhs.uk by Friday 30th March 2018 at the latest.

Lisa Burnapp- Lead Nurse, Living Donation

Appendix 1: UKLKSS Performance

[pic]

Appendix 2: Consultation: Donor Complexity and Information Sharing in the UKLKSS

UK Living Kidney Sharing Schemes (UKLKSS): Fixed Time Working Group (FTWG)

Friday 19th January 2018

Actions and Outcomes: DRAFT FOR CONSULTATION

Aims of the FTWG (see appendix A for membership)

1. Agree criteria for registering donor complexity within the UKLKSS to reduce variability, support decision-making for individual recipients and simplify the complex matching run.

2. Agree minimum data set for sharing donor-recipient information between centres within the UKLKSS to ensure safety and accuracy, simplify administration processes and inform any future development of an electronic offering system (living EOS).

1. Donor complexity relevant to the acceptance of a donated kidney

The following additional donor information (complex donor information) is required for any donor to be included in the complex donor matching run prior to each quarterly matching run*. These criteria meet the requirements of the latest UK Guidelines for Living Donor Kidney Transplantation at .uk and are relevant to the acceptance of a kidney from the registered donor.

|Complex Category |Specification |Comments |

|Kidney function |Absolute GFR (Isotopic or equivalent) |Required for all complex donors |

| | |Only include if relevant |

| |Unequal split function (1 renal artery (confirmed/expected) |Imaging report and outcome of MDT |

| |Polar arteries: position (upper, hilar, lower); size |discussion to be made available on |

| |(mms- if available) |request from other centres** |

|Non-vascular anatomy |Benign tumour; angiomyolipoma; simple cyst > 4cm and |Imaging report/s and outcome of MDT |

| |site |discussion to be made available on |

| |Pelvic ureteric junction obstruction |request from other centres** |

| |Stone or calcification in the kidney to be donated | |

|Medical history |Treated hypertension (on medication) |Evidence to be made available on |

| |Hepatitis B Core Antigen Positive |request from other centres |

| |Kidney biopsy for persistent non-visible haematuria | |

| |(if performed) | |

*The following information is required for all donors on registration in the UKLKSS:

Name, Sex, Ethnicity, Donor age, Blood group, HLA type

**Radiological reports, biopsy reports and outcomes of MDT discussions are available on request from centres for the complex matching-run.

Images and scans are available on request from centres once transplants have been confirmed in the quarterly matching run.

2. Minimum data set for sharing donor-recipient information between centres.

This data set represents the core data that is required by the recipient centre from the donating centre once possible transplants have been identified in the quarterly matching run. The requirements relate solely to the kidney that is being donated, the intended recipient and/or the destination of the kidney. ALL DATA TO BE TYPE WRITTEN.

|Information |Format Required |Check List* |

|Donor demographic information |Documented (may be hand-written/typed) | |

|Donor ID (NHSBT only) | | |

|Exchange ID (provided by NHSBT) | | |

|Donor Initials | | |

|Date of Birth | | |

|Sex | | |

|Recipient demographic information |Documented (may be hand-written/typed) | |

|Recipient ID (NHSBT) | | |

|Blood results |Laboratory/electronic patient record (EPR) reports showing | |

|ABO blood group |results specified e.g. CMV positive, HIV negative etc. | |

|Virology (within previous 3/12 or update with | | |

|initial xm if > 3/12) | | |

|Kidney function/Renal anatomy |Imaging/radiological report/s | |

|Absolute GFR |Documented MDT discussion outcome | |

|DMSA |Documented: right or left kidney | |

|Which kidney is being donated? |Complex donor information (see section 1) | |

|Vascular anatomy |Scans/images available on request. | |

|Non-vascular anatomy | | |

|Donor consent for destination of donated organ |Copy of Human Tissue Authority (HTA) consent | |

|(if not transplanted into the intended | | |

|recipient) | | |

|Free Text |Include any other relevant information that is relevant to the| |

| |donated kidney; intended recipient or final destination of the| |

| |kidney. | |

*To be completed by LDC in donating centre

To be completed IN TYPE by each centre involved in the identified exchange prior to surgery

|Donation-Transplantation Plan |

|Kidney Exchange ID | |

|Planned Date/s of surgery | |

|Centre/s Contact Details |

|Name of Centre: |Name of Centre: |

|Coordinator Tel: |Coordinator Tel: |

|Theatre – Main Theatre |Theatre – Main Theatre |

|Surgeon retrieving Tel: |Surgeon retrieving Tel: |

|Surgeon Implanting Tel: |Surgeon Implanting Tel: |

|Out of hours contact Tel:* |Out of hours contact Tel:* |

|*in case of urgent pre-admission query/change of circumstances |*in case of urgent pre-admission query/change of circumstances |

|Name of Centre: |Name of Centre: |

|Coordinator Tel: |Coordinator Tel: |

|Theatre – Main Theatre |Theatre – Main Theatre |

|Surgeon retrieving Tel: |Surgeon retrieving Tel: |

|Surgeon Implanting Tel: |Surgeon Implanting Tel: |

|Out of hours contact Tel:* |Out of hours contact Tel:* |

|*in case of urgent pre-admission query/change of circumstances |*in case of urgent pre-admission query/change of circumstances |

|Day of Surgery: Donor Nephrectomy Plan (estimated times) at [insert centre name] |

|[Insert time agreed]- Confirm donor and recipient are well and can proceed |

|[Insert time agreed]- Confirm donor in anaesthetic room and anaesthetic due to be administered |

|[Insert time agreed]- Collection of outbound kidney for transportation |

|Outbound kidney- Right/Left (delete as required) |

|[Insert time agreed]- Estimated time of arrival of inbound kidney in recipient centre |

|Inbound kidney-Blue light request? Yes/no (delete as required) |

|Donor Centre: Point of Collection and Address |Recipient Centre: Point of Delivery and Address |

|[name of centre] donor to [name of centre] recipient |[name of centre] donor to [name of centre] recipient |

| | |

| | |

| | |

| | |

|Donor Centre: Point of Collection and Address |Recipient Centre: Point of Delivery and Address |

|[name of centre] donor to [name of centre] recipient |[name of centre] donor to [name of centre] recipient |

| | |

| | |

| | |

| | |

|Donor Centre: Point of Collection and Address |Recipient Centre: Point of Delivery and Address |

|[name of centre] donor to [name of centre] recipient |[name of centre] donor to [name of centre] recipient |

| | |

| | |

| | |

| | |

|Information to accompany kidney in Organ Box |Form FRM4131/3 (inc. last 5 digits of organ box no.) |

| |Exchange ID |

| |Recipient ID (NHSBT no. only) |

| |Confirmation of donor blood group |

| |Donor HTA consent for destination of donated organ |

Appendix A: Fixed Time Working Group: Membership

|Name |Role and Affiliation |

|Jeanette Ayres |Histocompatability and Immunogenetics, Oxford |

|Lisa Burnapp |Lead Nurse Living Donation, NHSBT (Chair) |

|Rhian Cooke |Living Donor Co-ordinator, Cardiff |

|Keith Graetz |Consultant Surgeon, Portsmouth |

|Iain Harrison |Product Owner -ODT, NHSBT |

|Katrin Jones |Consultant nephrologist, Newcastle |

|Nizam Mamode |Consultant Surgeon; LDKT 2020 ‘recipients at higher immune risk’ workstream lead |

|Matthew Robb |Senior Statistician, NHSBT |

|Lin Shelper |LKD Schemes Coordinator, ODT Hub |

|Lisa Silas |Living Donor Co-ordinator, Guy’s & St. Thomas’ |

|Matthew Wellberry-Smith |Consultant nephrologist, Leeds |

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