3/20/2012

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OPTN

KPD Basics:

Insights from Transplant Centers,

Big and Small

March 21, 2012

Ruthanne L Hanto RN, MPH

Suzanne McGuire RN, BSN, CCTC

Coleen Smart MSN(c), BSN, RN

OPTN

Objectives

Explain the benefit for KPD

Define standard KPD terminology and types

of exchanges

Describe ways that two different transplant

centers have incorporated KPD into their

practice

Describe how to enter pairs into the OPTN

KPDPP

Provide information on future webinars

Answer your questions

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OPTN

Benefit of KPD

Segev, et al JAMA 2005

1/3

OPTN

3000 more kidney

transplants/year

Segev, et al JAMA 2005

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OPTN

KPD Match Run

OPTN

Types of KPD

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OPTN

Donor Chains

KPD Insights –

Building a Team

and Spreading the Word

Suzanne McGuire, RN, BSN, CCTC

High Risk and Living Donor Exchange Coordinator

UCLA Kidney and Pancreas Transplant Programs

3/20/2012

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Starting your KPD Program

• Identify key personnel

• Put processes in place

• Identify potential KPD pairs

• Get the word out to your patients

KPD Team Champions

• Director:

• Surgeon

• Nephrologist

• Transplant Coordinator(s)

• Living Donor TC

• Waitlist TC

• Immunogenetics

• Financial

• Social Worker, ILDA

• Administration

• Operating room

• Inpatient staff

• OPO

• Courier

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Physician Leaders

• KPD Director

• Establish/modify policy for KPD vs standard living donor (LD) transplant

• Voice of your KPD program

• Point person for Coordinator

• Communicate w/KPD Directors at other centers

• Nephrologist

• Review donor, recipient acceptability for exchange

• Surgeon

• Review of donor suitability (anatomy)

• Liaison with the OR for any logistical issues

Transplant Coordinators

• Primary resource for patient/team education

• Communication in-center, between centers, between patients

• LD TC facilitates donor workup

• Add’l tests needed

• Waitlist TC facilitates recipient readiness

• Diagnostics, consultations

• Connecting all the dots

• Becoming expert at “Plan B”

• Close work with other centers’ coordinators

• You are the of KPD success!

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Immunogenetics Lab Champions

• Identifying KPD crossmatch specimens

• Accurate, consistent processing

• Expeditious turnaround time

• Enter/review HLA entries on donors, recipients

• Current unacceptable antigen profiles

• Guidance on sensitized recipient matches

• Risk tolerance for un/acceptable donor specific antibodies – team effort

w/physicians, TCs

• Is the “positive” crossmatch really unacceptable?

Financial Counselors

• Connect directly with Contracting, Administration, other centers

• Analyze recipient transplant coverage

• Update patient/team on benefits/limitations

• Medicaid, MediCal reimbursement

• Hospital vs Professional Fees

• Assure all information in place for proper payment/reimbursement

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Social Worker,

Independent Living Donor Advocate (ILDA)

• Social Worker Assesses:

• Recipient’s acceptance

• Recipient expectations about

communication

• Donor readiness to give to a

stranger rather than intended

recipient

• Be cognizant that barrier to

donation has been removed

• ILDA Assesses:

• Donor feelings of coercion or

obligation

• Donor awareness of recipient

(and donor) risks

• Donor empowerment by

possibilities of KPD

• Donor expectations of post-

donation communication

Administrative Leaders

• Support KPD Participation

• Analyze staffing needs for KPD program

• Financial decisions for insurance issues –

• Billing and Reimbursement

• Communicate w/Admin at other centers

• Support for patients/families

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Champions in the O/R

• Confirm all documentation in place

• Connect with donor/recipient OR teams

• Assure time-outs are documented

• Timely policy implementation

• Adjust procedures to new regulations

• Constructive ideas

• Protect patient privacy

Inpatient Staff Leaders

• Patient room assignment to maintain anonymity

• Relate to donors on a positive level

• Communicate accurately at shift change

• Avoid sharing patient stories if pairs are placed

in close proximity

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Connections at the OPO

• Placement coordinator guidance:

• Organ transportation

• Backup match runs

• Procurement/surgical tech specialist guidance:

• Prepare and package organs

• Draw/package blood for backup crossmatch

• Perfusion if needed

Courier Champions

• Best connections for:

• Ground and air transport

• Charter services if needed

• Backup plans if primary transport fails

• GPS devices

• Track organ travel

• Alert if pathway deviates from plan

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Identifying Incompatible Pairs

• Waitlisted patients without a donor in process

• New referrals – educate early about options

• Compatible pair wants better match (age)

• Consider risk stratification, time on waitlist

• Are organ offers coming now?

• High risk for early graft loss or death

• High risk for rapid disease recurrence

A reminder …

• Kidney Paired Donation has changed

Live Donor Transplantation

• Removing the incompatible barrier to transplant =

• “No excuse” not to donate

• Donor may feel obligated or coerced

• Recipients more focused on the goal

• May be forceful with potential donors

• May disregard laws against payment

• Be sensitive to non-verbal cues

• Just because they can, doesn’t mean they should

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Don’t underestimate…

• “Paired exchange,” “kidney swap”, “pay it forward” or “KPD” may be familiar to some, but not to others

• Don’t underestimate the need to educate

• Many still don’t know about it!

Processes and Procedures Forms, Education, and

Selection Criteria

Coleen Smart MSN(c), BSN, RN

Living Kidney Transplant Coordinator

Pediatric Coordinator

KPD Program Coordinator

Hartford Hospital Transplant Program

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• Finance

• Key Champions

– Operating Room

– Inpatient Staff

– OPO

– Histocompatibility Lab

Comparing Apples to Oranges

Required OPTN KPDPP Documentation

• Agreement to Participate Form

• Education Documentation Forms

• Authorization for Disclosure of Medical Information – HIPPA (no template – yet)

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Agreement to Participate Form (same format for both the Donor and Recipient)

• What is the OPTN KPD Pilot Program?

• What happens if we agree to join?

• What personal information is needed, how will it be used and how will it be kept confidential?

• What are the risks of participation?

Agreement to Participate Form (continued)

• What are the risks of shipping a kidney?

• What are the benefits?

• What are the chances a match will be identified?

• What are the alternatives?

• What are the costs?

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Educational Information and Materials

Education Brochure

found on the

UNOS online store

- FREE

http://store.unos.org

Donor Education

• Welcome/Information Letter

• Initial Phone Screening

• KPD Information Packet

• Follow-up Phone Call

• Quick Work-up Evaluation Day

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Donor Education Form

• Donation is a personal choice

• Donation is an Educated Decision

• Lack of Medical Benefit for the Donor

• Independent Donor Advocate

• Evaluation of the Donor

• Disclosure of Medical Information

• Medical Risks

• Psychosocial Risks

Donor Education Form (continued)

• Financial Risks

• Donation Follow up

• Risks of Shipped Living Donor Organs

• Non-Directed Donors

• Logistics of KPD

• Anonymity Between Pairs

• Possible Untoward Events

• Commitment of Pairs to Exchange

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Candidate Education

• Welcome Information Packet

• Quick Work-up Day

• Yearly Follow-up

Recipient Candidate Education Form

• Logistics of KPD

• Anonymity Between Pairs

• Possible Untoward Events

• Commitment of Pairs to Exchange

• Risks of Shipped Living Donor Organs

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Required Forms Key Points

• Consent for participation – only

• Individual program must maintain documentation in chart

– Informed consent

– Education document

– HIPPA form

http://communication.unos.org/category/optn-kpd-program/

Staff Education

• Transplant Staff

– Bi-weekly education

•Hospital Staff

•Individual Departments

•Annual Educational Transplant Symposium

•Transplant Core Classes for Nurses

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Getting the Word out About KPD

•Letters

•Website Links

•Pamphlets

•Other KPD pairs

KPD Donor Medical Evaluation

Make It Simple

OPTN KPD Evaluation Criteria

+

Programs Existing Evaluation

=

One policy

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Patient Selection Criteria

• Follow your centers existing

specific selection criteria

• Consider outcome risk factors

OPTN

Entering Pairs in OPTN KPDPP

Center signs agreement

Center activated in UNet™

Site administrator grants staff access

Enter pairs

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OPTN

Mark your Calendars

Future KPD Webinars

Sorting the Finances of KPD

April 19th 2:00 – 3:00 PM ET

Unacceptable antigens in KPD

June 20th 2:00 – 3:00 PM ET

Navigating the Logistics of KPD

July 25th 2:00 – 3:00 PM ET

A B DR

DP DQ