Collaboration, focus drive transplant success rate at Northwest Kidney Centers

According to 2014 dialysis facility reports from the Center for Medicare & Medicaid Services, the standardized transplantation rate among dialysis patients at Northwest Kidney Centers is 1.8, or 80% better than the national average.

Eight percent of Northwest Kidney Centers patients received a transplant during CMS’ most recent report period, compared to 5% across the country. NKC has 28% of its dialysis population on the transplant waitlist; 25% is average.

The nonprofit dialysis provider serves 1,500 patients, 80% of those who need dialysis in its region. Nephrology News & Issues ranks it as the 10^th largest dialysis provider in the country, and it is influential in the field because of its high quality services, deep community connections, and generous donor support.

Northwest Kidney Centers’ leadership has long been passionately committed to transplantation as the best treatment for the right candidates. Recognizing that passion needs an action plan, and several years ago the organization formed an internal task force to put transplantation in the spotlight.

A staff nephrologist who serves as liaison to the city’s transplant surgery programs and coordinates the internal focus on paving the way for transplants led the task force.

The task force identified key activities to make promoting transplant part of the organization’s culture

Patient education
Tracking each patient’s transplant status
Involvement of the entire interdisciplinary care team
Collaboration with transplant programs and other community partners

Patient education

Northwest Kidney Centers’ education about transplant starts long before a patient needs dialysis. A free modality class called Choices presents transplantation as the best treatment for the right individuals. Last year, a total of 679 people attended Choices; just over half were patients and the remainder were family members.

For people interested in exploring the topic in more depth, Next Step Transplant class covers the evaluation process, donors, the waitlist, and more. Attendees report positive forward movement and increased motivation to work on becoming actively listed for a kidney transplant.

The key messages in pre-transplant classes are relatively simple:

Kidney transplant is the best treatment for some patients.
The transplant evaluation process takes a long time, so it’s wise to begin early.
Living related and living unrelated transplants have the best outcomes, so patients must proactively look for a donor. While the wait in Seattle for a cadaver kidney has historically been two to five years, shorter than in some parts of the country, Northwest Kidney Centers actively encourages patients to search for a living donor. The organization teaches transplant candidates to spread word of their need by telling their story in a practiced “elevator speech.”

We also provide educational tools to patients post-transplant.

Living Well with a Transplant is taught by a renal pharmacist and a renal dietitian, who cover how to live long and well. (Northwest Kidney Centers’ specialty pharmacy is available to all transplant patients.)
An educational newsletter, Transplant Connection, is mailed twice a year to all transplant recipients. Topics are relevant to the audience: medication compliance, the importance of flu vaccination and sunscreen, coping with depression.

Another way Northwest Kidney Centers educates the community is by sharing patient stories. For example, when a home dialysis patient was scheduled to receive a transplant in a 12-step paired living donor exchange, the dialysis provider and transplant center jointly arranged publicity. A local TV crew followed the patient into the surgical suite and produced a comprehensive report after his recovery. A minute-by-minute Twitter feed during the procedure generated 89,000 impressions and comments to raise transplant awareness.

Status tracking

Robust tracking in Northwest Kidney Centers’ electronic medical record lets every member of the care team know each patient’s status: Is he or she a transplant candidate? Has a transplant evaluation been completed? Was the patient denied? Is he or she waiting for a procedure to be done? Tracking closely helps caregivers understand their role to navigate the patient along in the process. A transplant coordinator on the staff communicates with all local transplant programs to keep patient status records current.

IDT involvement

Northwest Kidney Centers expects the interdisciplinary team to address transplant as an issue for every patient. Team members are responsible to address barriers that would prevent a patient from getting on the list: nurse educators inform patients one-on-one about the option of a transplant (for all new patients and then on a regular basis). If overweight/obesity is a problem, the dietitian works with the patient; if smoking is an issue, the social worker will help the patient address it; if past transfusions have led to sensitization, the physician may order intravenous immunoglobulin infusion to reduce preformed antibodies that could interfere with transplant.

To make sure staff members are current on transplant-related issues, Northwest Kidney Centers held an in-house Transplant School last year. The full-day continuing education conference focused on IDT roles in guiding patients through the transplant process. Speakers came from every Seattle transplant program—including physicians, registered nurses, and a social worker. They discussed transplant innovations, what types of patients make good candidates, living donation and paired exchange networks, and upcoming changes in organ allocation.

Collaboration

Initial funding and ongoing resources for our transplant initiatives have come from the local community via Northwest Kidney Centers special events and gifts from individuals, foundations, corporate matching gifts, and Indian tribes. In all, the community has contributed more than $300,000 to help pay for curriculum development and to fund a transplant fellowship for a nephrologist in training at the University of Washington School of Medicine. The Seattle area is blessed to have three excellent kidney transplant programs––Swedish, Virginia Mason and University of Washington medical centers. Each achieves excellent outcomes for graft and patient survival. The four institutions collaborate collegially in many areas of patient care and education. For example, they recently co-published a patient nutrition manual, Eating Well After a Kidney Transplant. Dietitians at nearby nonprofit Puget Sound Kidney Centers also participated in the nutrition project.

Another important collaboration is with the King County Dental Society. Dentists donate services for Northwest Kidney Centers dialysis patients who lack dental insurance and who couldn’t otherwise get dental clearance for a transplant. In the past five years, 32 patients have received a kidney transplant after getting volunteer dental services through the program.

Summary

The first step toward creating a successful transplant culture like we have in Seattle is having leaders who understand that transplant truly is the best option for certain patients. A dialysis organization must create infrastructure that addresses patients’ needs before, during and after transplant. Patient education and IDT involvement are essential. And working in collaboration with local transplant programs, other health care providers and community partners can propel such an initiative to success. -by Leanna Tyshler, MD