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Canadian Blood Services is responsible for operating and managing national interprovincial organ sharing registries and for leading the development of national initiatives and leading practices that will improve and increase organ and tissue donation and transplantation (OTDT) in Canada. Between 2008 and 2017, the living kidney donation (LKD) rate in Canada decreased by 12%. It is a strong possibility that this drop was influenced by potentially modifiable factors related to training, education, and support for the identification of living kidney donors.
In response, Canadian Blood Services’ Living Donation Advisory Committee (LDAC) identified a priority need for increasing LKD by helping potential transplant candidates identify living kidney donors. In response, Canadian Blood Services hosted an Advancing Living Donation Forum focused on the identification of Living Kidney Donors on January 23 and 24, 2020, in Toronto, Ontario, Canada.
The Forum brought together 50+ clinical experts, kidney transplant recipients, transplant candidates and living kidney donors from across Canada to develop consensus recommendations. The perspectives of those who have gone through the living kidney donation process, who are actively looking for a living kidney donor, and who have received a kidney from a living donor were critical to the development of the recommendations in this report.
Participants agreed that a focus on improving and increasing patient and professional education was expected to increase identification of potential living kidney donors, and so raise the number of actual living kidney donor transplants in Canada. Research consistently demonstrates that a lack of knowledge and awareness about the benefits of living kidney donation among patients, health care providers and the public is an important and modifiable factor contributing to the current low rates of LKD. For example, one published needs assessment found that “…a majority [of frontline staff] also did not feel empowered to discuss [Living Donor Kidney Transplantation] LDKT with their patients…” and that “…approximately one-third of patients in advanced [Chronic Kidney Disease] CKD clinics were not adequately informed about [kidney transplantation] KT as a treatment option”1.
In planning the Forum, it was agreed that discussions would be designed with the understanding that the kidney transplant candidate was to be considered the centre of the education and awareness recommendations. The agenda was designed to follow the journey of the chronic kidney disease (CKD) patient along the continuum of their care, from chronic kidney disease clinics, to dialysis clinics (if applicable), to pre-transplant care. Accordingly, CKD clinic staff, dialysis providers, transplant nephrologists and kidney transplant candidates were key participants in the development of the recommendations.
The purpose of the Forum was to develop pan-Canadian consensus on recommendations for improving the identification of potential living kidney donor candidates.
Objectives were to:
The Forum recommendations follow the journey of the potential recipient from the chronic kidney disease (CKD) clinic, to being on dialysis if applicable, through to the transplant assessment process. These recommendations represent the “best case” scenario. Potential transplant candidates and living donation and transplant programs will incorporate them as each situation allows.
Forum consensus was achieved on the following statements:
This section describes the patient experience across the spectrum of End Stage Kidney Disease (ESKD) care, a key topic for Forum discussions. The collective wisdom and experience of the living kidney donors and recipients present, and of the health providers, is included here as context for the recommendations.
Individuals in all the care settings listed above may be at various stages of readiness to explore transplant. Therefore, considerations based on stage of readiness are included in this report.
a) Forum participants recommend across all three settings of patient care (CKD clinic, dialysis units/clinics, transplant centres) that:
b) Additionally, for the CKD Clinics, forum participants recommend that:
7. LDKT be presented as the preferred treatment for those who may be eligible, before discussing other options.
8. Nephrologists and other members of the care team in CKD clinics raise LDKT as a consideration at the earliest opportunity with patients.
9. A referral to a transplant centre for assessment of transplant eligibility be part of the standard of care, if deemed appropriate by the referring Nephrologist.
A health care professional with frequent contact with patients on dialysis (e.g., the patient’s primary nurse, in some units) takes on a primary role in discussing LDKT, with additional dedicated staff available to provide advanced education.
c) Forum participants recommend across all three settings of patient care that:
d) Forum participants recommend across all three settings of patient care:
e) Forum participants recommend across all three settings of patient care that:
Forum participants discussed helping a patient to find a living donor in the context of the stages of readiness to be able to discuss LDKT after a diagnosis of ESKD. For the purposes of this report we have selected three main states of readiness for recommendations: Pre-contemplation, contemplation and action.
In the pre-contemplation stage, one can expect an individual to be unaware, unable or unwilling to discuss LDKT. In this stage, it is helpful to establish a rapport with the patient, introduce the idea of LDKT, acknowledge the patient’s thoughts, feelings, fears and concerns, and provide awareness of the possibility of LDKT.
In the contemplation stage, the patient may be ambivalent or uncertain about their interest and feelings about LDKT. The person is interested in discussing LDKT and assessing potential barriers to LDKT (discomfort with asking a potential donor, time and expense for the donor, etc.). At this stage, patients may be more receptive to receiving information and begin to ask questions about the process and what it might mean for them and the potential donor. Clarifying the patient’s needs by asking questions such as, “What’s most important to you and why?” is often important during the contemplation stage.
When the patient is ready to act, they demonstrate steps toward behavior change (preparation) such as asking for tools to help with donor identification and approaching family and friends.
For patients assessed as being in a pre-contemplation2 stage of readiness, Forum participants recommend the following messages/approaches across all settings:
For patients assessed as being ready to contemplate LDKT, Forum participants recommend the following key messages or approaches across all settings:
For patients assessed as in the stage of readiness to act, Forum participants recommend the following action across all settings:
While system-level improvements were not the focus of this forum, Forum participants did acknowledge the importance of system performance.
Forum participants recommend the following system-level considerations for all renal and transplant programs:
Health providers at the Forum shared and discussed their experiences from their own programs. These are included here, in their own words, as part of guiding the implementation of recommendations in this report.
The participating donors and transplant recipients provided vital contribution to the Forum. Their stories motivated and inspired everyone in the room. When asked for any insights and reflections on the Forum, the following comments were offered:
From transplant recipients:
Meeting participants expressed great appreciation for the opportunity to participate in this meeting. Not only was the in-person meeting very helpful for putting faces to names and providing opportunities for networking, the following sentiments about the success of the meeting were included in the “other comments” section of the meeting evaluation form:
Canadian Blood Services held another forum in 2019 that focused on defining the requirements for a single, national living donor registration portal. The report contains recommendations that the portal include a repository of educational information on living donation. Ideas generated at the Advancing Living Donation Forum reinforce the necessity for that portal, and, importantly, the need for national standardized materials.
Canadian Blood Services is committed to an ongoing and long-term focus on increasing living donation rates in Canada. The recommendations from this Forum will help guide new and ongoing initiatives aimed at advancing, improving and increasing living kidney donation.
Dr. Sunita Singh, Chair of the Forum Planning Committee, thanks participants for their time and energy. She felt it was a terrific Forum and extremely beneficial to hear and learn from such a diversity of perspectives.
Dr. David Landsberg, Vice-Chair of the Forum Planning Committee said the meeting had exceeded his expectations and that he was happy to hear that people were working together toward a common goal. He thanked donors and recipients for sharing their voices – noting that he had attended many meetings, and this was the first time he had seen such natural patient engagement – and extended his appreciation, on behalf of everyone, to the organizers for making the event possible.
A Steering Committee with broad representation from Canadian living donation and transplant programs was formed (see Appendix 1). Chaired by Dr. Sunita Singh, the committee, assisted by an external facilitator from Strachan-Tomlinson, developed the process, prepared background materials and reviewed and gave final approval for the recommendations developed at the Forum.
The process was designed to bring together as wide a range of perspectives as possible to build recommendations for Canada. The 54 participants included living kidney donors, kidney transplant recipients, nephrologists of varying subspecialties (transplant, living donation, chronic kidney care clinic, dialysis, community nephrology), social workers, living donor coordinators, pre-transplant coordinators, pharmacists, an ethicist, a transplant ambassador coordinator, a modality education nurse, dialysis nurses, and an Aboriginal liaison coordinator.
The forum opened with presentations from a kidney transplant recipient, a living kidney donor, and clinical experts, followed by a question and answer session. Participants were seated in groups of mixed clinical perspectives, with either a living kidney donor or kidney transplant recipient at each table. Discussions took place in small and large group settings, with pre-defined worksheets to be completed to build the recommendations.
An emphasis during the forum was on the need to help patients help themselves. The goal was to develop actionable recommendations that can be shared with Canadians in need of a kidney transplant, as well as the care providers who help them along their journey of care. The participants were selected to represent a broad community of care for patients with chronic kidney disease and kidney failure, and as such, will have the opportunity to advocate and champion the recommendations with their peers and their programs.
This Forum is one of a set of complementary initiatives being led by Canadian Blood Services to advance living kidney donation and transplantation, which include the development of an on-line Living Donor Registration Portal (LDRP) for potential donors to be able to find information about living donation and to begin the registration and potentially the evaluation process, and the development of a network of Living Donation Program managers, coordinators and quality assurance personnel to allow the community to collaborate, solve challenges and share best practices to optimize living kidney donation at all programs. Additionally, Canadian Blood Services operates the Kidney Paired Donation Program for Canada that increases living kidney donor transplant opportunities for patients who have a willing but medically incompatible living donor. The donors help their incompatible pair by participating in a chain of donor swaps so that all the candidates receive a medically suitable living donor kidney transplant.
With more than 3,200 patients on the waiting list for a kidney transplant as of December 31, 2018, and some 100 dying each year, there is a critical need to help to close the gap between demand for kidney transplants and donor availability by increasing living donation.
Dr. David Landsberg, Co-Chair of the Forum Steering Committee and Chair of LDAC provided the challenge address. He noted that while deceased donation had seen successes in the past, living donation has remained relatively flat, saying “the time has come for us to reinvest and drive living donation forward”.
He presented data showing the advantages of receiving a living donor kidney transplant over chronic dialysis therapy, if transplantation is a medical option for the patient. LDKT has a strong survival advantage over chronic dialysis therapy even in carefully selected, high-risk groups. Those who receive living donor kidney transplants enjoy better quality of life (at a lower cost to the health system) than those transplanted from dialysis.
Dr. Landsberg pointed to significant regional variations in the living donation rate as opportunity for significant gains. For example, in British Columbia the living donation rate per million population was well above the national average and is in some regions comparable to the highest rates internationally.
Some of the factors contributing to the success of the living kidney donation program at his hospital (St. Paul’s Hospital in Vancouver) include: funding and cultural support for living donation, dedicated social workers trained in living donor education and outreach, working up multiple donors for a transplant candidate simultaneously, a strong emphasis on participating in the Kidney Paired Donation (KPD) program with a healthy but medically incompatible donor, and a responsive surgical group that gives pre-emptive transplants a high priority.
The final message of his address was that pursuing “Living Donor Kidney Transplant First” was not a challenge to be afraid of but one to be pursued. Since shifting its efforts in this direction, British Columbia’s pre-emptive transplant rate has risen to 35-40 percent of their kidney transplants and the number of living donors in the province is steadily moving upward. His final message: “What are we afraid of? Humans are generous by nature – we just need to do a better job of asking!”
Following Dr. Landsberg’s address, participants heard from three separate perspectives.
Dale Orton took part in a paired exchange program after volunteering to donate a kidney to a friend. He described a positive overall experience in which he felt well informed, had empathy and support from the nurses and transplant staff, and the helpful opportunity to speak to someone who had already been through the procedure.
Mr. Orton also mentioned a sense that many who decide to donate do so with little contemplation or reflection, and that they may reconsider further into the living donation assessment process. He also discussed how difficult it was to travel to another province for surgery.
Stephen Case received a living donor kidney transplant in August 2019. As a private person, it was only through the intervention of a family member that a donor came forward.
Mr. Case said he had felt well educated throughout the process and that his only recommendation was to discuss the paired exchange program first, as many patients ruled themselves out of being able to find a living donor because they mistakenly thought they had to have a donor with the same blood type. He mentioned that his attitude towards living donation had changed over the course of the process, and that he was glad someone had championed his cause to others.
Transplant nephrologist Dr. Shaifali Sandal presented highlights of her recent research4 on health professional-identified barriers to living donor kidney transplantation, noting that the focus tends to be on patient/recipient barriers to donation, but that there are other barriers at the referral, transplant centre, and system levels. These include health professionals’ uncertainty about interventions, cost, difficulties for people of lower socio-economic status, and the onus being placed on those who are sick (e.g., on dialysis) to help themselves by finding a living donor.
Many health professionals felt they didn’t have adequate information or training and were not comfortable discussing living kidney donor transplantation with patients. Dialysis nurses were in the best position to discuss LDKT with patients, but two thirds didn’t feel comfortable doing so. Some health professionals were not providing the appropriate information to their teams or to patients, and there were patient-level barriers as well (e.g., stigma, language and cultural differences, age, substance use, etc.) that may be contributing to low LDKT rates.
Dr. Sunita Singh, Medical Director of the Living Kidney Donation Program at Toronto General Hospital, presented an overview of the background research reviewed by the Forum Steering Committee with a focus on initiatives aimed at increasing living kidney donor transplantation rates.
For patients, the main barriers identified in the research are:
From the Health Professional’s perspective, the barriers include:
Dr. Singh noted the potential for modifying these barriers and described tested interventions in education, the evaluation process, and related to social media.
Education strategies that have been proven effective at increasing patient knowledge relating to LDKT included: house calls to provide information to recipients and their families and friends, sessions with social workers (at home or in the transplant centre), targeted and culturally sensitive information sessions, patient navigators (social workers) in community nephrology clinics, weekend seminars, and the recruitment of living donor champions. Several educational strategies are also being tested in Canada include ongoing work with the Explore Transplant Ontario Program and the Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD) study being led by Dr. Amit Garg.
Streamlining the evaluation process for potential donors has also been tested with some success. In Northern Ireland, the adoption of a one-day donor assessment model supported a sustained increase to LDKT rates. In the U.S., the use of web-based screening increased the number of self-referrals. Dr. Singh noted that Canadian Blood Services is developing a national, online donor registration portal to serve a similar purpose.
Social media is another area of promise: Twitter and Facebook are being used by donors and health professionals to share stories and research and to find living donors. A study on the impact of a Facebook app used by transplant centres to help transplant candidates find living donors and a donor champion showed not only a shorter time to first donor referrals but also a much greater likelihood (6.6 times) of a living donor coming forward. Important considerations around social media included the need for a level of technological capability and legal and ethical issues related to fairness, privacy, and coercion.
Dr. Sunita Singh, Chair; MD, MSc, FRCPC
Dr. Sunita Singh is a transplant nephrologist in the Division of Nephrology and the medical director of the living kidney donation program at the Toronto General Hospital, University Health Network. She is also an Assistant Professor of Medicine at the University of Toronto. Dr. Singh completed medical school at the University of Toronto, and internal medicine and chief medical residency at the University of British Columbia. She returned to Toronto to complete a Master of Science in clinical epidemiology and health care research, as well as additional fellowship training in kidney transplantation and advanced diabetes care. Dr. Singh’s research interests are focused on the evaluation and follow-up of living kidney donors, as well as the management of diabetes in kidney transplant recipients.
Dr. David Landsberg, Vice-chair; MD
Dr. David Landsberg is a transplant nephrologist. He did his nephrology and transplant training at the University of Toronto. He moved to UBC in 1984 and established a new kidney transplant program at St. Paul’s Hospital in Vancouver. He is the chair of the Living Donor Advisory Committee, Canadian Blood Services. He is a passionate advocate for transplantation and living donation.
Dr. Ann Bugeja, MD, FRCPC
Dr. Ann Bugeja completed her medical degree, internal medicine and nephrology training at the University of Toronto. She is an Assistant Professor of Medicine at the University of Ottawa. She is the lead for the Living Kidney Donation and In-Centre Nocturnal Hemodialysis Programs at The Ottawa Hospital with clinical research interests in these areas. Dr. Bugeja is also involved with mentorship and education and received the 2017 Undergraduate Teaching Award at the University of Ottawa.
Dr. Sandra Cockfield, MD
Dr. Sandra Cockfield received her both her undergraduate and medical degrees from the University of Toronto. After completing residency training in general internal medicine and nephrology in Toronto, she joined the laboratory of Dr. Philip Halloran for a research fellowship focused on the regulation of MHC expression and its relationship to cytokine gene expression in a variety of murine models. She joined the Faculty of Medicine at the University of Alberta in 1990 and is currently a Professor in the Division of Nephrology and Transplantation Immunology at the University of Alberta. She has served as Residency Program Director (1993-1999), Clinical Program Director of the Northern Alberta Renal Program (1998-2002) and is currently the Medical Director of the Renal Transplant Program and the Living Donor Program.
Ms. Maureen Connelly, RN BSc
Maureen Connelly is a Living Kidney Donation Coordinator at St. Michael’s Hospital Transplant Program in Toronto, Ontario. Maureen has extensive nursing experience in kidney transplantation and living kidney donation as well as critical care and emergency/trauma. She has presented at national and international conferences. She has shared her expertise in consulting roles with Trillium Gift of Life Network, the Ontario Ministry of Health, the Kidney Foundation, the Canadian Counsel of Donation &Transplantation and Canadian Blood Services. She was part of the original team to initiate the Kidney Paired Donation protocol between St. Michael’s and Toronto General Hospital prior to the option becoming a national reality. She has been a member of the CBS Living Donor Advisory Committee since its inception and was a contributor to the CBS Kidney Donor Protocol.
Dr. Christine Dipchand, MD, FRCPC
Professor of Medicine, Nephrology, Dalhousie University. Interests are Living Kidney donation. Christine is a member of the Living Donor Advisory Committee and is the Medical Director of living kidney donation for Multi-organ Transplant Program in Atlantic Canada.
Dr. Amit Garg, MD, PhD, FRCPC, MA, FACP
Dr. Amit Garg is the Director of their Living Kidney Donor Program at the London Health Sciences Centre where he also provides nephrology care to patients in multi-care kidney clinics and hemodialysis units. He recently co-Chaired the new International KDIGO Clinical Practice Guidelines in Living Kidney Donation and serves as the Medical Lead for the Ontario Renal Network to Enhance Access to Kidney Transplantation and Living Kidney Donation in Ontario. He is well versed in transplant and living kidney donor records in large provincial databases, and is the Lead for the Ontario ICES Kidney, Dialysis and Transplantation (ICES KDT) Program. He has research experiences to share, with over 80 peer reviewed publications in living kidney donation (which has featured in the NEJM, Lancet, Ann Intern Med, J Am Soc Nephrol, Am J Transplant and other leading medical journals). As a Professor of Medicine, Epidemiology and Biostatistics at Western University, he is funded for living kidney donor research by the federal government and other sources. He has served on the Canadian Blood Services, Living Donor Advisory Committee since its beginning.
Dr. Rahul Mainra, BSc, MD, MMed, FRCPC
Dr. Rahul Mainra is a Transplant Nephrologist working in the Division of Nephrology at St. Paul’s Hospital in Saskatoon, Saskatchewan. He is the director of UGME for the Department of Medicine at the University of Saskatchewan. He is the current vice-chair of the Kidney Transplant Advisory Committee.
Ms. Ruth McCarrell, RN BSN
Ruth has had a long nursing career with over sixteen years as the Clinical Nurse Leader for the Living Kidney Donor and Kidney Recipient Pre-Transplant Programs at St. Paul’s Hospital, Vancouver, BC. She has been a key advisor on many provincial and national committees including as a working member of the Canadian Blood Services’ Living Donation Advisory Committee.
Dr. Michel Pâquet, MD, Ph.D., FRCP(C)
Dr. Michel Pâquest is a Transplant Nephrologist and Medical Director of the Kidney Living Donation Program at CHUM, Montréal. He is an Assistant Professor at the Université de Montréal and the Medical Advisor for Living Donation & Transplantation at Canadian Blood Services.
Mr. Clay Gillrie, RN, BSN, MSN; Senior Program Manager, Living Donation and Transplantation, Canadian Blood Services, Vancouver, BC
Ms. Charley Bekolay; Program Associate, Living Donation and Transplantation, Canadian Blood Services, Edmonton, AB
Dr. Janice Bissonnette, RN, PhD; Senior Program Manager, Living Donation and Transplantation, Canadian Blood Services, Edmonton, AB
Mr. Mike Tomlinson, Facilitator; Strachan-Tomlinson, Ottawa, ON
Ms. Kathy Yetzer, B.Comm, BSc.(Pharm); Associate Director, Living Donation and Transplantation, Canadian Blood Services, Edmonton, AB
Ms. Jenny Ryan, BA (Hons); Manager, Program Operations, Organ and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON
Ms. Sadia Baig, BSW; Programs Coordinator at the Kidney Foundation of Canada and on dialysis, Mississauga, ON
Dr. Mike Bevilacqua, MD, FRCPC; Medical Lead for the Polycystic Kidney Disease Network for the BC Renal Agency and Clinical nephrologist in Fraser Health Authority, BC
Ms. Fannie Blanchet; Living Donor Kidney transplant recipient, Cumberland, BC
Mr. Stephen Case; Living Donor Kidney transplant recipient, Toronto, ON Dr. Marie Chantal-Fortin MD, Ph.D., FRCP(C); Principal Scientist Division of Nephrology, CHUM Research Centre, Montreal, QC
Ms. Candice Coghlan; Living Donor Kidney transplant recipient, Kitchener, ON
Ms. Jana Costa, RN; KPD and HSP Transplant Coordinator, Foothills Medical Centre, Calgary, AB
Dr. Olivier Diec, MD; Community Nephrologist, Hospital Charles Lemoyne, President of South Shore Branch of Quebec Kidney Foundation, Montreal, QC
Ms. Lindsey Doxtator; Program Manager, Kingston Health Sciences Centre, Kingston, ON
Dr. Kathy Ferguson, MD; Community Nephrologist, Moncton NB
Ms. Arlene Funnell, RN; Recipient Coordinator, Kingston Health Sciences Centre, Kingston, ON
Ms. Melissa Giroux, RN, CNE; Chronic Kidney Disease Clinical Nurse Educator, Edmonton AB
Ms. Julie Gratton-Edwards RN, BN; Living Donor Kidney Coordinator, Winnipeg Health Sciences Centre; Winnipeg, MB
Ms. Tricia Hutton, BSW, RSW; Medical Social Worker Hemodialysis Unit, Saskatoon, SK
Ms. Carolyn Jarvis MFA, BFA, BSW; Social Worker, Vancouver, BC
Dr. Olwyn Johnston; Medical Director Kidney and Pancreas Transplant; Vancouver General Hospital Transplant Nephrologist; Gordon and Leslie Diamond Centre, Vancouver, B.C.
Dr. Bruce Jones MD; Community Nephrologist, Charlottetown, PEI
Ms. Leslie Jones; Report Writer, Ottawa, ON
Dr. Joanne Kappel, MD, FRCP(C); Head Division of Nephrology for the College of Medicine and Dyad Co-Lead for Kidney Health Services, Saskatoon, SK
Mr. Dani Khanafer; Senior Policy Analyst, Health Canada, Ottawa, ON
Dr. Ngan Lam, MD, FRCP(C), MSc; Associate Professor, Division of Nephrology, University of Calgary, Calgary, AB
Ms. Lydia Lauder; Kidney Foundation of Canada Representative, Toronto, ON
Dr. Darius Lazarus MD; Nephrology Specialist, Centre intégré de santé et des services sociaux de l'Outaouais, Gatineau, QC
Dr. Sarah MacDonald, MD; Transplant Nephrologist, Gatineau, QC
Ms. Lisa Martin RN; Living Donor Kidney Coordinator, Queen Elizabeth II Health Sciences Centre, Halifax, NS
Dr. Sean Martin MD, BSc; Community Nephrologist, NFL
Ms. Jessica McDougall, RN, BScN, MN; Living Donor Kidney Coordinator, The Ottawa Hospital, Ottawa, ON
Dr. Matthew Miller, MD, BSc, FRCP(C); Living Donor Nephrologist, St Joseph’s Healthcare Hamilton, Hamilton, ON
Ms. Beth Montesi, RN; Living Donor Coordinator, London Health Sciences Centre, London, ON
Mr. Dale Orton; Living Kidney Donor, QC
Ms. Andrea O’Shaughnessy, RN, BsN; Recipient Coordinator, Vancouver General Hospital, Vancouver, BC
Ms. Glenda Peebles; Aboriginal Liaison Coordinator for the Manitoba Renal Program and a living kidney donor for her sister, MB
Dr. Shaifali Sandal, MD, FRCP(C); Transplant Nephrologist, McGill University Health Center, Montreal, QC
Ms. Christina Schellenberg; Renal Social Worker, Vancouver, BC
Dr. Khaled Shamseddin, MD, MSc, FRCP(C); Associate Professor of Medicine and Transplant Nephrology, Director, Kidney Transplant Program; Director, Napanee Dialysis Clinic Kingston General Hospital, Kingston, ON
Ms. Nancy Sparrow, RN, CNeph(C); Transplant Coordinator, Pre-emptive and Independent Dialysis Programs, Trafalgar Memorial Hospital, Oakville, ON
Ms. Lori Van Manen, RN BSN; Program Operational Director, Renal and Palliative Care Service, Kingston Health Sciences Centre, Kingston, ON
Ms. Valentina Vexelshtein, RN; Registered Nurse Kidney Care Clinic, Mackenzie Health, Richmond, ON
Ms. Angela Wishnowski, RN, BScN, CNeph(C); Pre-Renal Transplant Coordinator, University of Alberta Hospital, Edmonton, AB
Ms. Janet Wright; Living Donor Kidney Recipient, Toronto, ON
|CKD||Chronic Kidney Disease|
|ESKD||End Stage Kidney Disease|
|LDKT||Living Donor Kidney Transplant|
|LDAC||Living Donation Advisory Committee|
|LDKT||Living Donor Kidney Transplant|
|LKD||Living Kidney Donation|
|OTDT||Organ and Tissue Donation and Transplantation|
|LDAC||LDAC includes representatives from all of Living Donation Programs in Canada and provides strategic and operational oversight and advice related to living kidney donation in Canada. https://professionaleducation.blood.ca/en/organs-tissues/program-overview/living-donation-advisory-committee-ldac|
1 Mucsi I, Novak M, Toews D, et al. Explore Transplant Ontario: Adapting the Explore Transplant Education Program to Facilitate Informed Decision Making About Kidney Transplantation. Can. J. Kidney Health Dis. 2018;5;1-9. doi.org/10.1177/2054358118789369
2 Pre-contemplation, Contemplation, and Action are a simplified version of a commonly used patient readiness model first presented in: Prochaska, J.O. and DiClemente, C.C. (1983) Stages and processes of self-change of smoking, toward an integrative model of change. Journal of Consulting and Clinical Psychology, 51, 390-395.
3 Enhance Access to Kidney Transplantation and Living Kidney Donation - ClinicalTrials.gov
4 Sandal, S., Charlebois, K., Fiore, J. F., Wright, D. K., Fortin, M.-C., Feldman, L. S., … Weber, C. (2019). Health Professional–Identified Barriers to Living Donor Kidney Transplantation: A Qualitative Study. Canadian Journal of Kidney Health and Disease. https://doi.org/10.1177/2054358119828389
This report provides an overview of the Advancing Living Donation: Helping Transplant Candidates Identify Living Donors Forum, held in January 2020 and summarizes participant recommendations in response to prescribed questions. The consensus recommendations were developed with the collaborative wisdom of a broad range of stakeholders and experts who provide care along the kidney transplant candidate’s journey through chronic kidney disease clinics, various dialysis modalities and the transplant eligibility evaluation process; transplant recipients, transplant candidates and living donors were also included. The Steering Committee would like to collectively thank Canadian Blood Services, the forum facilitator Mike Tomlinson and the participants who helped in the execution of the workshop and the creation of these recommendations. They also wish to acknowledge Dale Orton, a living kidney donor, and Stephen Case, a kidney transplant recipient, for sharing their experiences as patients. This first-hand experience helped to ground the forum and situated the participants to the circumstances facing Canadians in need of a kidney transplant.
© Canadian Blood Services, 2020. All rights reserved.
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Canadian Blood Services assumes no responsibility or liability for any consequences, losses or injuries, foreseen or unforeseen, whatsoever or howsoever occurring, which might result from the implementation, use or misuse of any information or recommendations in this report. This report contains recommendations that must be assessed in the context of a full review of applicable medical, legal and ethical requirements in any individual case.
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Donation and Transplantation
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