News and notices Pānui
Streamlined kidney transplant workup programme saves time, addresses inequity
04 August 2023
A one-day kidney transplant workup programme, allowing patients with Chronic Kidney Disease to complete numerous tests on the same day, has significantly sped up the process for prospective recipients.
A one-day kidney transplant workup programme, allowing patients with Chronic Kidney Disease to complete numerous tests on the same day, has significantly sped up the process for prospective recipients.
The programme’s primary aim is to reduce barriers to achieving a listing on the kidney transplant waitlist and to reduce inequities of access for patients with chronic kidney disease to transplant. It does this by streamlining and shortening the time taken to complete the normal renal transplant workup investigations.
And it’s working; as a direct result of the programme three patients have already been placed on the national transplant list, with a total of 17 others being enrolled, many of whom are now waiting for review by Specialist Transplant Teams from Auckland Regional Transplant Group.
“One of the many challenges for renal transplants is the ability to get patients through the workup process in a timely manner and listed on the national renal transplant wait list,” explains Hauora a Toi Bay of Plenty Nephrologist Dr Scott Crawford.
In June, Dr Crawford presented the one-day renal transplant workup programme (ODRTW) nationally to the Te Whatu Ora and Te Aka Whai Ora Clinical Quality Assurance Committee. Dr Crawford said the committee was very supportive of exploring the potential of introducing this programme to other renal centres as a new ‘model of care’. They recognised its impact on reducing inequities which exist for patients who may benefit from kidney transplants, particularly those who are regional, rural and remote.
The gold-standard treatment pathway for people with advanced chronic kidney disease is to receive a pre-emptive renal transplant before dialysis treatment is required. To achieve this, patients need to go through a long series of educational steps and assessments. This comprehensive process may take months or years, dramatically affecting the chance a patient may complete their workup before they need dialysis (in the case of a pre-emptive transplant) or whilst remaining eligible to receive a donor kidney.
“There are clear disparities in the rates of transplant listing between different ethnic groups, with Māori and Pasifika less likely to be listed or to receive a renal transplant even when listed,” says Dr Crawford.
“This disparity is even more stark when considering the rates of pre-emptive renal transplant for Māori patients. In the last five years, throughout Aotearoa, just seven Māori patients have been provided with a pre-emptive kidney transplant, compared with 125 non-Māori patients. This disparity is then further exacerbated by Māori experiencing longer waiting times once on the list and they are therefore less likely to receive a transplant within their window of opportunity.”
Prior to the programme, people would need to make multiple visits to various health settings to attend specialist investigations. The financial cost for patients and their whānau was significant, with many ‘hidden costs’. The impact of time, loss of work, and the costs of travel, parking, and accommodation over a period of months and often, years was substantial. This long process magnified inequities in access for Māori and those living rurally/remotely.
“The renal service at Bay of Plenty recognised this burden and the enormous benefits if many of the specialist investigations could be prioritised for patients on a single day. These investigations may involve cardiology, dental, clinical physiology, radiology, and bloods and urine workups.
“Our Renal Scheduler coordinates with all the Planned Care departments and scheduling teams to line up the required investigations on a given day. She is able to provide clear instructions outlining all of the appointments and ensure that there is a common single point of communication for the patient. The patient-centred programme has also improved collaboration between planned care schedulers themselves, who feel a bigger part of the whole process.”
The programme has reduced the time to transplant listing, removed some of the costs and burdens, improved access, and reduced inequity for patients and their whānau. Te Pare ō Toi has wrapped support around for patients, involving assistance with parking, transport, food, and a place to rest, refresh and re-energise.
So far, 42% of the patients taking part in the single day renal transplant workup have been Māori. Patient feedback has been positive; “great and easy to navigate”, “so much easier – all good”, “one day makes it better”, and “absolutely makes sense!”.
The programme is a cross-departmental effort between Te Whatu Ora – Health New Zealand Hauora a Toi Bay of Plenty’s Renal service, the Māori health service Te Pare o Toi, and the various planned care services which provide the investigations.