Process Improvement in Living Donor Kidney Transplant Education

Background: End-stage renal disease (ESRD) is a leading cause of death in the United States. Organ availability is a significant barrier to transplantation. Living donor kidney transplant (LDKT) is the most optimal treatment and reduces transplant wait times, yet it is underutilized, with rates plateauing over the past decade.

Local Problem: ESRD is the tenth leading cause of death in the state of Tennessee. Low levels of education have been identified as barriers to transplant. Patients who receive LDKT education from health professionals have higher levels of knowledge than patients who do not receive education. This project was completed at a single transplant center, performing below national benchmarks for LDKT. This evidence-based practice quality improvement (EBPQI) project aimed to standardize patient education of living donation and to improve patients’ readiness to pursue LDKT.

Methods: The Model for Improvement served as a framework, guiding the nurse in identifying a clinical problem and synthesizing available literature to address it. Synthesis of the literature revealed a strong recommendation for implementing a standardized, LDKT-specific education process delivered in the home setting, with encouraged inclusion of patients’ support systems. Pre and post-intervention surveys measured patient readiness to pursue LDKT (primary outcome) and tracked staff compliance (secondary outcome).

Interventions: Evidence-based standardized LDKT education was delivered in patients’ homes, enabling inclusion of their support systems and providing access to the information prior to the in-person transplant evaluation appointment. This approach helped establish a baseline of knowledge and fostered shared decision-making.

Results: Patient readiness to pursue LDKT improved by 20%. All participants either maintained or improved in readiness. Staff adherence data were not captured due to staffing limitations.

Conclusions: A standardized, LDKT-exclusive education process positively impacted patient readiness to pursue LDKT. Broader implementation could increase transplant rates, reduce wait times and achieve healthcare system cost savings, while moving the site closer to national benchmarks.