The Variation in Practice of the Living Donor Kidney Transplant Pathway in the UK: Results of a National Survey
Living donor kidney transplantation (LDKT) accounts for 35% of kidney transplants in the UK. The Organ Donation and Transplantation 2030 initiative underscores the necessity to enhance LDKT rates to meet growing demand. There is limited data on national variations in live donor workup pathways from initial referral to long-term follow-up. We conducted an online survey across all 23 UK transplant centres performing LDKT, covering the entire living donor pathway. We aimed to explore and highlight practice variation and identify opportunities for improvement. Responses were received from 21 centres (91.3%). Marked variation was identified in donor acceptance criteria, including age limits, body mass index thresholds, and donor evaluation timelines (6-36 weeks). Differences were also noted in multidisciplinary team processes, kidney laterality decisions, and perioperative enhanced recovery protocols. All centres used laparoscopic techniques, with hand-assisted transperitoneal nephrectomy being most common (57.1%). Donor nephrectomy and implantation were conducted sequentially in 15 (71.4%) of centres, and in parallel in six (28.6%). Variation was also seen in follow-up duration with 47.6% of centres offering lifelong follow-up. Despite excellent national outcomes, this survey highlights significant variation. Standardising key processes could streamline donor pathways, improve experiences, and support increased LDKT activity in the UK.
Authors
- Matthew Welberry Smith (ORCID: https://orcid.org/0000-0002-9018-6827)
- Sanjay Mehra (ORCID: https://orcid.org/0000-0002-9792-3375)
- Francis Calder (ORCID: https://orcid.org/0000-0002-0261-4378)
- Nicholas Inston (ORCID: https://orcid.org/0000-0002-9411-6367)
- Imeshi Wijetunga (ORCID: https://orcid.org/0000-0002-4128-7381)
- Tim Brown (ORCID: https://orcid.org/0000-0002-7104-6431)
- David van Dellen (ORCID: https://orcid.org/0000-0002-5695-6939)
- Paul Gibbs
- Lisa Burnapp (ORCID: https://orcid.org/0000-0002-3757-4003)
- Argiris Asderakis (ORCID: https://orcid.org/0000-0001-6859-2020)
- Zia Moinuddin (ORCID: https://orcid.org/0000-0002-9125-8116)
- James Hunter (ORCID: https://orcid.org/0000-0002-4972-6879)
- William Norton (ORCID: https://orcid.org/0000-0002-3244-0145)
- Mortimer Kelleher
- Lorna Marson (ORCID: https://orcid.org/0000-0003-4156-5107)
- Abul Siddiky
- Sarah Browne
- Robin Youngs (ORCID: https://orcid.org/0000-0002-0202-540X)
- Hemant Sharma (ORCID: https://orcid.org/0000-0003-3781-1651)
- Hannah J. Maple (ORCID: https://orcid.org/0000-0001-5050-0562)
- James Yates (ORCID: https://orcid.org/0000-0003-0433-5900)
- Titus Augustine (ORCID: https://orcid.org/0000-0002-7391-1839)
- Alistair Rogers (ORCID: https://orcid.org/0000-0001-5805-5723)
- Kailash P. Bhatia (ORCID: https://orcid.org/0000-0001-8108-1196)
- Josh Stephenson
- Ahmed Hamsho
- Rafique Umer Harvitkar (ORCID: https://orcid.org/0000-0002-0830-6675)
- Atul Bagul (ORCID: https://orcid.org/0000-0002-8146-1946)
- Katie Connor
- Shahzar Malik
- Reza Motallebzadeh (ORCID: https://orcid.org/0000-0002-5399-9546)
- K Nightingale (ORCID: https://orcid.org/0000-0001-6109-5996)
- Abbas Ghazanfar (ORCID: https://orcid.org/0000-0003-0084-5057)
- Rommel Ravanan (ORCID: https://orcid.org/0000-0003-3324-9024)
- Rajesh Sivaprakasam (ORCID: https://orcid.org/0000-0002-6145-4642)
- Kamran Haq
- Badri Man Shrestha (ORCID: https://orcid.org/0000-0002-7309-7080)
- Frank J. M. F. Dor
- T. Campbell
- Michael Nicholson
- Imran Saif
- Kashuf Khan
- Stuart Falconer
- Adam Barlow
- Sanjay Sinha (ORCID: https://orcid.org/0000-0003-4921-4387)
- Andrew Sutherland (ORCID: https://orcid.org/0000-0001-9927-1764)
- Victoria Boardman
- Michael Moneke
Institutions
- Belfast Health and Social Care Trust (GB)
- Cardiff and Vale University Health Board (GB)
- North Bristol NHS Trust (GB)
- NHS Blood and Transplant (GB)
- University Hospitals Birmingham NHS Foundation Trust (GB)
- NHS Lothian (GB)
- Nottingham University Hospitals NHS Trust (GB)
- University of Ulster (GB)
- University of Liverpool (GB)
- Imperial College Healthcare NHS Trust (GB)
- Royal Free London NHS Foundation Trust (GB)
- Guy's and St Thomas' NHS Foundation Trust (GB)
- Barts Health NHS Trust (GB)
- Queen Elizabeth Hospital Birmingham (GB)
- Leeds Teaching Hospitals NHS Trust (GB)
- Royal Devon & Exeter NHS Foundation Trust (GB)
- Leicester General Hospital (GB)
- The Royal Free Hospital (GB)
- Churchill Hospital (GB)
- St George’s University Hospitals NHS Foundation Trust (GB)
- Royal Devon and Exeter Hospital (GB)
- Southmead Hospital (GB)
- St James's University Hospital (GB)
- Newcastle upon Tyne Hospitals NHS Foundation Trust (GB)
- University Hospital Coventry (GB)
- Hammersmith Hospital (GB)
- Northern General Hospital (GB)
- Freeman Hospital (GB)
- Manchester Royal Infirmary (GB)
- University Hospitals of Leicester NHS Trust (GB)
- University Hospitals Coventry and Warwickshire NHS Trust (GB)
- Derriford Hospital (GB)
- Royal Liverpool University Hospital (GB)
- Queen Alexandra Hospital (GB)
- Belfast City Hospital (GB)
- University of Manchester (GB)
- University of Oxford (GB)
- Manchester University NHS Foundation Trust (GB)
- Sheffield Teaching Hospitals NHS Foundation Trust (GB)
- Queen's Medical Centre (GB)
- Ashford and St Peter's Hospitals NHS Foundation Trust (GB)
- Queen Elizabeth University Hospital (GB)
- University Hospitals Plymouth NHS Trust (GB)
- University College London (GB)
- University of Birmingham (GB)
Publication Details
- Journal
- Transplant International
- Published
- 2025-11-12
- DOI
- https://doi.org/10.3389/ti.2025.15341
- Primary Topic
- Organ Donation and Transplantation
- Type
- article
- Field-Weighted Citation Impact
- 0.00