Impact of a Transplant Nurse Navigator in the Dialysis Setting

Patients with kidney disease have better patient outcomes and quality of life with a kidney transplant. However, the transplant process is complicated with inherent inequalities and biases and patients frequently fail to initiate a referral for transplant evaluation. The Centers for Medicare and Medicaid have now placed financial incentives to improve the number of patients transplanted. The only way to increase the number of patients transplanted is to start with a referral for evaluation. Studies have been done highlighting the barriers, but there is a lack of studies implementing strategies to improve these numbers. Utilizing Kotter’s change theory and describing the transplant referral process as a complex adaptive system, this project proposed that in the adult chronic kidney disease population on incenter hemodialysis, implementing a transplant nurse navigator in the dialysis unit as compared to social work driven transplant referrals would improve kidney transplant referral rates over 1 month. This project was conducted in an outpatient adult incenter hemodialysis center in the Southwest United States with approximately 75 end-stage renal disease patients. Pre- and postintervention referral rates were compared with the anticipated outcome that referral rates would increase and subsequently increase the number of patients placed on the national wait list and eventually transplanted. The findings of the study showed that with the intervention of the transplant nurse navigator, referral rates increased 200% suggesting that the nurse navigator educating, encouraging, guiding, and coaching patients was successful for those patients who would benefit from being listed for a kidney transplant.