NKF Position Statement: ...Advance Transplant Access and Outcomes

Clark · July 30, 2021, 03:37:53 PM

https://www.ajkd.org/article/S0272-6386(21)00628-4/fulltext

POSITION STATEMENT

A Roadmap for Innovation to Advance Transplant Access and Outcomes: A Position Statement From the National Kidney Foundation

Krista L. Lentine
Stephen Pastan
Sumit Mohan [/color]Kevin Longino
Matthew Cooper ∗
David A. Axelrod ∗
et al
on behalf of the National Kidney Foundation

Published:July 27, 2021 DOI:https://doi.org/10.1053/j.ajkd.2021.05.007

Over the past 65 years, kidney transplantation has evolved into the optimal treatment for patients with kidney failure, dramatically reducing suffering through improved survival and quality of life. However, access to transplant is still limited by organ supply, opportunities for transplant are inequitably distributed, and lifelong transplant survival remains elusive. To address these persistent needs, the National Kidney Foundation convened an expert panel to define an agenda for future research. The key priorities identified by the panel center on the needs to develop and evaluate strategies to expand living donation, improve waitlist management and transplant readiness, maximize use of available deceased donor organs, and extend allograft longevity. Strategies targeting the critical goal of decreasing organ discard that warrant research investment include educating patients and clinicians about potential benefits of accepting nonstandard organs, use of novel organ assessment technologies and real-time decision support, and approaches to preserve and resuscitate allografts before implantation. The development of personalized strategies to reduce the burden of lifelong immunosuppression and support "one transplant for life" was also identified as a vital priority. The panel noted the specific goal of improving transplant access and graft survival for children with kidney failure. This ambitious agenda will focus research investment to promote greater equity and efficiency in access to transplantation, and help sustain long-term benefits of the gift of life for more patients in need.

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Priority 1: Expand Opportunities for Safe Living Donation and Access to LDKT
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Improve education and outreach to kidney patients about effective strategies for potential donor identification;
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Reduce financial disincentives to donation;
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Improve the efficiency of donor evaluations and predonation processes, with particular attention to removing disincentives and logistical barriers to KPD participation for programs and patients;
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Optimize donor risk assessment and long-term follow-up; and
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Identify and implement methods to improve risk communication, transparency, and shared decision-making in the donor candidate evaluation.

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Priority 2: Improve Waitlist Access, Management, and Pretransplant Readiness
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Priority 3: Decrease Organ Discard by Expanding Clinician and Patient Organ Acceptance
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Priority 4: Decrease Organ Discard With Use of Novel Assessment Technologies and Real-Time Decision Support
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Priority 5: Develop and Implement Strategies to Preserve, Resuscitate, or Evaluate Kidney Allografts Before Implantation
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Priority 6: Sustain One Transplant for Life
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Priority 7: Optimize Kidney Transplantation for Pediatric Patients
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NKF Position Statement: ...Advance Transplant Access and Outcomes

Clark