Maintaining Equity and Access: Successful Implementation of a Virtual Kidney Transplantation Evaluation

J Am Coll Surg. 2021 Apr;232(4):444-449. doi: 10.1016/j.jamcollsurg.2020.12.003. Epub 2020 Dec 21.

Abstract

Background: Maintaining access to kidney transplantation during a pandemic is a challenge, particularly for centers that serve a large rural and minority patient population with an additional burden of travel. The aim of this article was to describe our experience with the rollout and use of a virtual pretransplantation evaluation platform to facilitate ongoing transplant waitlisting during the early peak of the COVID-19 pandemic.

Study design: This is a retrospective analysis of the process improvement project implemented to continue the evaluation of potential kidney transplantation candidates and ensure waitlist placement during the COVID-19 pandemic. Operational metrics include transplantation volume per month, referral volume per month, pretransplantation patients halted before completing an evaluation per month, evaluations completed per month, and patients waitlisted per month.

Results: Between April and September 2020, a total of 1,258 patients completed an evaluation. Two hundred and forty-seven patients were halted during this time period before completing a full evaluation. One hundred and fifty-two patients were presented at selection and 113 were placed on the waitlist. In addition, the number of patients in the active referral phase was able to be reduced by 46%. More evaluations were completed within the virtual platform (n = 930 vs n = 880), yielding similar additions to the waitlist in 2020 (n = 282) vs 2019 (n = 308) despite the COVID-19 pandemic.

Conclusions: The virtual platform allowed continued maintenance of a large kidney transplantation program despite the inability to have in-person visits. The value of this platform will likely transform our approach to the pretransplantation process and provides an additional valuable method to improve patient equity and access to transplantation.

MeSH terms

  • Adult
  • Aged
  • COVID-19 / epidemiology*
  • COVID-19 / prevention & control
  • COVID-19 / transmission
  • Female
  • Health Services Accessibility / organization & administration*
  • Humans
  • Kidney Transplantation*
  • Male
  • Middle Aged
  • Patient Selection*
  • Referral and Consultation / organization & administration
  • Renal Insufficiency / diagnosis
  • Renal Insufficiency / etiology
  • Renal Insufficiency / surgery*
  • Retrospective Studies
  • Telemedicine / organization & administration*
  • Waiting Lists