Maintaining Equity and Access: Successful Implementation of a Virtual Kidney Transplantation Evaluation - 23/03/21

Doi : 10.1016/j.jamcollsurg.2020.12.003

Vinayak S. Rohan, MD, FACS ^⁎ , Nicole Pilch, PharmD, BCPS, Deborah Cassidy, MS, John McGillicuddy, MD, FACS, Jared White, MD, FACS, Angello Lin, MD, FACS, Satish N. Nadig, MD, PhD, FACS, David J. Taber, PharmD, MS, BCPS, Derek Dubay, MD, FACS, Prabhakar K. Baliga, MD, FACS
Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, College of Medicine, Charleston, South Carolina

^∗Correspondence address: Vinayak S Rohan, MD, FACS, Division of Transplant Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, CSB 409, Charleston, SC 29425.Division of Transplant SurgeryMedical University of South Carolina96 Jonathan Lucas St, CSB 409CharlestonSC29425

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.

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