UK Altruistic Kidney Donation Trends & Data Insights
Explore the nine-year experience of non-directed altruistic kidney donation in the UK, including living donor transplant rates, total kidney transplants, national arrangements for donor allocation, and long-chain donation statistics. Gain insights into the dynamics of altruistic unspecified kidney donation in the UK from 2007 to 2015.
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Non-directed altruistic (unspecified) kidney donation in the UK nine year experience Rachel Johnson, Iain Harrison, Lisa Burnapp NHS Blood and Transplant, UK ELPAT 2016
The UK context 23 kidney transplant centres, 64m population First altruistic unspecified and paired living kidney donors in 2007
Living donor (LD) kidney transplant rates 2010 30 28.5 25 transplants pmp 19.8 20 18.217.9 16.916.6 14.6 15 10 8.1 5.1 4.8 4.5 4.4 4.2 5 3 2.4 2 1.3 1.3 0.9 0 Italy Hungary UK Switzerland Germany USA Finland Norway France Greece Sweden Poland Denmark The Netherlands Portugal Spain Latvia Croatia Slovakia Country Source: Council of Europe Transplant Newsletter
Total LD kidney transplants in UK 1200 1104 1097 1041 1034 1027 1026 982 1000 924 804 Number of transplants 800 600 400 200 0 2007 2008 2009 2010 2011 2012 2013 2014 2015
Altruistic unspecified living kidney donors National arrangements only for allocation Notified to NHS Blood & Transplant when fully worked up (including approval by Human Tissue Authority)
Altruistic Unspecified Donation in UK Direct to Waiting List 2007 Short AD Chain (ADC) Long ADC 2012 April 2015 Exception! If match for high priority patient on waiting list AD AD AD R1 D1 Couple from paired donation pool R1 D1 WL R1 D1 WL WL
Altruistic Unspecified Donation in UK Direct to Waiting List 2007 Short AD Chain (ADC) Long ADC 2012 April 2015 AD AD AD R1 D1 R1 D1 WL R1 D1 WL WL
Altruistic Unspecified Kidney Donors Long chains Donation type 140 120 Into chain Direct to list 100 Short chains 23 22 No. of donations 21 80 3 60 87 85 40 73 57 20 35 26 3 16 12 0 2007 2008 2009 2010 2011 2012 2013 2014 2015
Altruistic Unspecified Kidney Donors Long chains Donation type 140 Extra transplants Into chain Direct to list 23 120 22 33 100 Short chains 23 No. of transplants 22 21 80 3 3 60 By December 2015: 87 85 40 73 463 Donations 57 20 35 544 Transplants 26 3 16 12 0 2007 2008 2009 2010 2011 2012 2013 2014 2015
Altruistic and Paired Living Donor Kidney Transplants Transplant according to exchange type 250 Altruistic donor to wait list Altruistic donor chain 200 73 No. of transplants 3-way exchange 150 87 85 2-way exchange 54 100 57 46 44 35 60 6 50 26 24 16 36 39 27 6 15 12 30 3 28 24 20 18 16 12 10 4 0 2007 2008 2009 2010 2011 2012 2013 2014 2015
Demographics of 463 Altruistic Unspecified Donors (2007-2015) Donor sex - 52% Male, 48% Female Interval from notification to donation Donor age Median: 2 months Range 0-9 months Mean: 54 yrs Range: 20-85 yrs 18 35 16 30 14 25 12 Percent 20 Percent 10 33 8 16 16 15 27 14 6 23 10 10 9 9 4 6 6 5 9 2 4 3 4 2 2 2 2 2 0 0 <1 1-2 2-3 3-4 4-5 5-6 >6 month months Interval between notification and donation months months months months months Donor age (years) Median (range) for: Donation to list: 1.5 mths (0-9) Donation to pool: 3.0 mths (1-6)
Altruistic donors choosing to donate to a chain 2012-2015 138 donors choosing chains (with known outcome) 22 allocated to high priority patients on waiting list (WL) (16%) 25 not matched in pool, donated to WL (eg AB) (18%) 91 matched in pool (66% of those choosing chain) 21 matches fell through (15%) (16 donated to WL, 5 withdrew) 70 donated in chain (77% of those matched) (51% of those choosing chain)
Summary National UK programme for altruistic unspecified living kidney donation: 463 donors 2007-2015 Usually donate to waiting list creating one transplant Since 2012, donation into chains possible total 544 transplants from 463 donations (1.2 transplants per donor) Donor chooses chain option 16% allocated to high priority waiting list patient 18% not matched (eg blood group AB) 15% match falls through 51% donate to chain Altruistic donors make significant contribution to LD activity More work to do ..UK Strategy for LD Kidney Transplantation 2020
Acknowledgements NHSBT colleagues Lisa Burnapp, Chloe Brown University of Glasgow (matching software) David Manlove NHSBT Kidney Advisory Group LDKT 2020 Strategy Implementation Group UK transplant and referring centres To match world class performance in living donor kidney transplantation Thank you
