Increasing Transplant Access with a Novel Care Model Employing Transplant Peer Navigators (TPNs)

Background: Kidney transplantation requires multidisciplinary planning and high levels of patient engagement. Geography, ethnicity, and other social determinants of health impact access to transplantation. We sought to improve access by identifying and removing barriers to transplant. Methods: A transplant nephrologist (EH) and TPNs (RE, JH, KN, LW) assessed patients with chronic kidney disease (CKD) referred by primary nephrologists. Medical record review, virtual visits, and transplant planning were independent of any one transplant center. TPNs are kidney recipients and donors who received additional formal training. TPNs partnered with patients through the life cycle of transplant, helping them address barriers, search for living donors, and secure care. Outcomes measured included referral, listing, transplant rates, and "net promoter score.” Results: Patients (Table 1) were referred between Oct 1, 2021 and Sept 30, 2023 from ME, NH, and MA. Results are in Figure 1. 43 (38%) had been referred to a transplant center but never listed, due to high BMI, medical and communication challenges, poor support, failure to complete tasks, and other barriers. We referred 21 of these to a 2nd center, and 5 to a 3rd, resulting in 16 listings and 5 transplants. 6 of 19 transplants occurred at the 2nd or 3rd center. 32 of 34 respondents rated the service a “10” (highly likely to recommend), and 2 others rated it 9 and 8. Conclusion: Using a novel TPN led, transplant center agnostic, and community-based model, 37% of patients were added to the kidney waitlist after previous denial. Patient satisfaction was high. Further study of our model's impact on access in other underserved populations is warranted. Funding: Clinical Revenue SupportTable 1Figure 1