UAB Medicine Kidney Transplant's New Living Donor Navigator Program

Additional Info

• Audio File:uab/ua030.mp3
• Doctors:Locke, Jayme
• Featured Speaker:Jayme Locke, MD, MPH
• CME Series:Quality and Outcomes
• Post Test URL:https://cmecourses.som.uab.edu/mod/quiz/view.php?id=4083
• Guest Bio:Jayme Locke, MD is a Transplant Surgeon with UAB Medicine.
  
  Learn more about Jayme Locke, MD 
  
  Release Date: August 16, 2017
  Reissue Date: July 23, 2020
  Expiration Date: July 23, 2023
  
  Disclosure Information:
  
  Planners:
  Ronan O’Beirne, EdD, MBA
  Director, UAB Continuing Medical Education
  
  Katelyn Hiden
  Physician Marketing Manager, UAB Health System
  
  The planners have no commercial affiliations to disclose.
  
  Faculty:
  
  Jayme E. Locke, MD, MPH, FACS
  Director, CTI Outcomes Research Center;
  Director, Transplant Analytics, Informatics & Quality;
  Director, Incompatible Kidney & KPD Program
  
  Dr. Locke has disclosed the following commercial interests:
  Grants/Research Support/Grants Pending – Sanofi
  Board Membership – Hansa Biopharma
  
  There is no commercial support for this activity.
• Transcription:Melanie Cole (Host): The Living Kidney Donation Program at UAB enables a healthy individual to donate a kidney to someone in need of a transplant. Because of the lack of available deceased donor organs, the Living Kidney Donation Program helps to meet the growing need for organs among those awaiting a kidney transplant. My guest today is Dr. Jayme Locke. She’s the director of the Incompatible Kidney Transplant Program at UAB Medicine. Welcome to the show Dr. Locke. Explain a little bit about living donor versus deceased donor transplant.
  
  Dr. Jayme Locke, MD, MPH, FACS (Guest): Absolutely. It’s great to be here. So, living donor versus deceased donor transplant really comes down to sort of longevity of the transplant, and what we know is that kidneys that come from living donors last longer and perform better than kidneys that come from deceased donors and intuitively that makes sense when you're talking about something that comes from a living person versus a deceased person, and so, whenever possible, it's always best for a potential transplant candidate to be able to achieve transplant by receiving a kidney from a living donor.
  
  Melanie: Are there studies that you can cite that discuss living donor kidney transplant recipients and the impact on post-transplant care?
  
  Dr. Locke: Not specifically on post-transplant care per se, but what I can tell you is that there are lots of studies that have looked at receipt of a living donor kidney transplant and long-term survival compared to receiving either a deceased donor kidney transplant or waiting on the waiting list and never actually receiving an organ offer and what those studies show is that patients who receive a live donor kidney live longer than patients who either receive a deceased donor kidney transplant or have to remain on dialysis.
  
  Melanie: Is there patient selection criteria specifically for living donor as opposed to deceased or not really?
  
  Dr. Locke: No, so we assess the potential transplant candidates in the same way. So, we want to make sure that our potential transplant candidate has a strong heart so a lot of cardiac testing is involved. We also want to make sure that they have a good functional status and are active, and we also want to make sure that the operation itself is technically possible for there are some studies involved in assessing the individual’s anatomy, if you will, to make sure that the blood vessels that we need to sew the new kidney into are in good shape, and that there's actually a spot for the new kidney.
  
  Melanie: So tell us about the Navigator Program at UAB Medicine for living donor kidney transplants.
  
  Dr. Locke: This was a program that really developed out of a recognition that there's quite a need in our community in that we have a lot of individuals in need of kidney transplants so we have on our deceased donor waiting list, but who just for whatever reason have not been able to identify a potential living kidney donor, and one of the things that we’ve discovered is that it's challenging for potential transplant candidates to have that conversation. If you step back for a moment, and kind of put yourself in a transplant candidate’s shoes and think about what would it be like if you needed a kidney, and you had to go and ask someone to be a living donor on your behalf. You think about the magnitude of that, and it at times can be kind of overwhelming, you know, how do you do that? How do you start a conversation? And really what the Navigator Program is designed to do is to help our transplant candidate develop tools to be able to start those conversations. The other thing that we’ve learned is that not every transplant candidate feels comfortable even with those tools, and so we’ve encouraged them to identify what we call a champion in their life. So this is an individual that knows the transplant candidate who themselves may not be able to be a living kidney donor for them, but can be their champion, help them get their story out, and we can teach them the tools about how to do that, how to start that conversation, and how to help that transplant candidate identify a potential living donor.
  
  Melanie: So, give us an example of how you would help them start that conversation.
  
  Dr. Locke: So, they come for a series of six classes, and the first series of classes, and I think it's important before you have any conversation is to really understand the data, if you will, and so the first few classes are really designed to teach them about the transplantation process, about living donation, how it works, what the risks are so they are truly informed, and then we have a series of classes where we really teach them about how to initiate the conversation and those classes, we tend to do things like role playing, and we have conversation starters that we provide them with. We do role playing where they have the opportunity to ask someone else in the class, you know, about being a living donor for them so that they can practice, and then we bring the class back after we've given them a homework assignment where we ask them to go out and speak to 10 to 20 different people, and we bring them back, and we go over things like what worked, what didn’t, what can we tweak, things like that, and I think just having a format for those types of discussions has proven very beneficial for people.
  
  Melanie: And Dr. Locke, what about the psychosocial aspects for the living donor? How is that addressed?
  
  Dr. Locke: That’s a very important thing to our transplant center, and I think all transplant centers in the country. It’s very important to us that number one there's no element of coercion involved and having someone come forward to be a living donor. As a part of the living donors – potential living donor’s evaluation, in addition to assessing their suitability from a medical and surgical standpoint, we also want to make sure that psychosocially, they are prepared for this. Number one that cognitively they have the capability to truly give informed consent and that we've addressed any social aspects as well and to ensure that there's no undue pressure or coercion involved, and so to accomplish that, we do two things. One, in addition to meeting with the surgeons and physicians, they meet with our social workers who get a sense of what their social environment is like, and we also have them meet with an individual that we call a living donor advocate, and this is a person who’s really there solely for the purpose to support the wishes of the living donor and make sure those are heard so that if we do have someone perhaps felt any sort of pressure and didn’t feel comfortable telling us, they would have the opportunity to talk to a living donor advocate and that could then be communicated and we can make sure that we help that individual with that decision.
  
  Melanie: And Dr. Locke, you mentioned coercion or pressure. What about guilt if there is no coercion or pressure, but that donor feels guilt, if I don’t donate, this person is going to die. How do you deal with that question?
  
  Dr. Locke: I think that’s a really good question as well. I think, you know, what I always tell people is that, you know, our transplant candidate, they need a lot of help, and they need a lot of support, and they only need one donor, and not everybody needs to be the donor and there are multiple roles an individual can play to help their loved one through the transplantation process, and I think really making people understand how much is involved and all the different ways they can plug in and help beyond just being the living donor, I think really helps people in that position.
  
  Melanie: And what about rejection? If somebody gives their kidney and then there is a possibility for rejection – do you have some valuable prognostic tools to aid in early diagnosis of rejection and how does that work with the living donor then? Is there a problem in that case?
  
  Dr. Locke: That’s a great question as well. So, there's still a lot of ongoing research to really develop prognostic tools. In truth, one of that things that we do is something called surveillance biopsies, and that’s probably the best tool we have right now at trying to find early rejection before it causes clinical dysfunction, and that’s proven very effective because it allows us the opportunity to intervene before the kidney really has any serious damage. So, that’s something that we try to do. We know that despite our best available therapies, you know, patients will experience occasionally episodes of rejection, but we also know that the vast majority, if they are able, you know, if they take their medicines consistently in the post-operative period, they should do quite well, and the risk for rejection with the current immunosuppression is quite low.
  
  Melanie: Are there some treatments or research that you're doing at UAB that other physicians might not be aware of?
  
  Dr. Locke: Well, I think one of the things that people may not be aware of is in fact the Living Donor Navigator Program – there are other programs across the country that are called Living Donor Champion Programs. Our Navigator Program is a little bit different in that not only does it help the potential candidate identify a champion to help get their story out and help identify the living donor, but once that potential living donor has been identified, and they enter our system, the Navigator Program is really designed to be there for the living donor and help them navigate the entire medical process and keep them plugged in throughout the course of their evaluation and provide an added layer of support and what we've seen with that is that we're slowly increasing our living donation rates, and so we're really excited about that. We’re continuing to study it and hope to have some publications in the not too distant future.
  
  Melanie: So, in summary Dr. Locke, tell other physicians what you'd like them to know about the kidney transplants new Living Donor Navigation Program at UAB and when they might want to refer?
  
  Dr. Locke: So, I think the one thing to know is that we are very committed to helping all of our transplant candidates achieve transplantation. Our goal would be to help everyone achieve live donor kidney transplantation because we know what patients get the best outcomes with that modality. Please refer your patients. Patients are eligible for listing, for transplantation as soon as their GFR is less than 20 cc/min, so we would encourage you to refer people preemptively so that we can be proactive and potentially help them identify a living donor and be transplanted before they ever have to go on dialysis. We know patients who can be transplanted preemptively do much better than patients who are transplanted off of dialysis.
  
  Melanie: And what can a physician expect from your team at UAB after referral in so far as communication with the referring physician and your team approach?
  
  Dr. Locke: Absolutely. So, you can expect to hear from us within a few weeks of the referral. Our goal is to have your patient scheduled for what we call Day One evaluation within a month of referral, and this is the day where they get all of their testing as well as come in for education. They then come back for a second day where they meet our entire transplant team which includes our transplant nephrologist, transplant surgeons, social workers, and the like and so – and we will send very rapidly communicate our decision back to the transplant referring nephrology team. We also try to make a concerted effort to let our referring physicians know when their patients achieve transplantation, and how they're doing. We really view this as a partnership between our UAB Transplant Program and our colleagues in the surrounding community. I think we all would like to see all of our end-stage renal disease patients be able to achieve transplant and live longer and healthier lives.
  
  Melanie: And how can a community physician refer a patient to UAB Medicine?
  
  Dr. Locke: So, you can go to our transplant website, and there's literally a button that you can click to make the referral. Also, our 1-800 number is listed on our webpage as well, and we’d be glad to hear from you.
  
  Melanie: And a community physician can refer a patient to UAB Medicine by using the MIST line that’s 1-800-UAB-MIST at 1-800-822-6478. You're listening to UAB Medcast. For more information on resources available at UAB Medicine, you can go to uabmedicine.org/physician. That’s uabmedicine.org/physician. This is Melanie Cole. Thanks so much for listening.
• Hosts:Melanie Cole, MS