# The Variation in Practice of the Living Donor Kidney Transplant Pathway in the UK: Results of a National Survey

## TL;DR

A survey of UK transplant centers reveals significant variation in living donor kidney transplant practices, suggesting standardization could improve efficiency and increase donations.

## Contribution

The study provides the first national survey of living donor kidney transplant pathways in the UK, identifying key areas of practice variation.

## Key findings

- Marked variation exists in donor acceptance criteria, evaluation timelines, and follow-up duration across UK transplant centers.
- Most centers use laparoscopic techniques, with hand-assisted transperitoneal nephrectomy being the most common approach.
- Standardizing key processes could streamline donor pathways and improve donor experiences.

## Abstract

Living donor kidney transplantation (LDKT) accounts for 35% of kidney transplants in the UK. The Organ Donation and Transplantation 2030 initiative underscores the necessity to enhance LDKT rates to meet growing demand. There is limited data on national variations in live donor workup pathways from initial referral to long-term follow-up. We conducted an online survey across all 23 UK transplant centres performing LDKT, covering the entire living donor pathway. We aimed to explore and highlight practice variation and identify opportunities for improvement. Responses were received from 21 centres (91.3%). Marked variation was identified in donor acceptance criteria, including age limits, body mass index thresholds, and donor evaluation timelines (6–36 weeks). Differences were also noted in multidisciplinary team processes, kidney laterality decisions, and perioperative enhanced recovery protocols. All centres used laparoscopic techniques, with hand-assisted transperitoneal nephrectomy being most common (57.1%). Donor nephrectomy and implantation were conducted sequentially in 15 (71.4%) of centres, and in parallel in six (28.6%). Variation was also seen in follow-up duration with 47.6% of centres offering lifelong follow-up. Despite excellent national outcomes, this survey highlights significant variation. Standardising key processes could streamline donor pathways, improve experiences, and support increased LDKT activity in the UK.

Title: "Variation in Living Donor Kidney Transplant Pathways Across the UK: Results of a National Survey." Illustration includes a checklist and a pencil with text indicating survey responses from 21 out of 23 UK transplant centers. A path icon represents the investigation of pre-operative, operative, and post-operative parts. Green text highlights significant national variation in pathways. The note emphasizes that standardization could optimize donor care and increase living donation in the UK. Bottom includes credit to K Nightingale et al., with a DOI link, alongside the ESOT and Transplant International logos.