Abstract: FR-PO0988
Improving Equitable Access to Kidney Transplantation from Ambulatory Dialysis Clinics Through a Patient-Driven Pathway
Session Information
- Transplantation: Clinical - Pretransplantation, Living Donation, and Policies
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Serwanska-Swietek, Marta, DaVita Poland, Wroclaw, Poland
- Magrian-Greener, Gabriela Iwona, DaVita Poland, Wroclaw, Poland
- Brzosko, Szymon, DaVita Poland, Wroclaw, Poland
Background
In Poland, kidney transplantation (Ktx) surgery is performed at the hospital where the organ is procured, requiring patients to travel to the organ. Ambulatory dialysis clinics do not operate 24/7, resulting in systemic inequities in access to Ktx when deceased donor organs become available outside clinic hours. A major challenge was the lack of nephrologist availability during off-hours, which could prevent patients from undergoing ktx or lead to procedural delays.
In 2018, DaVita launched a quality improvement initiative to ensure timely transplant access for patients with ESKD treated in ambulatory settings.
Methods
Each waitlisted patient received a Transplant Folder containing a communication script, transport contact list, medical document organizer, and a Local Transplant Card, which was updated by a physician during every HD session to confirm clinical readiness and exclude contraindications. Patients were trained to respond to transplant coordinator calls, self-assess symptoms, and arrange transportation. The system was integrated with the national transplant network and made available to all transplant centers. Data on transplant calls and outcomes were analyzed over a 72-month period.
Results
Of 779 KTx performed, 514 (66%) occurred during clinic hours using the standard pathway. 265 (34%) took place outside clinic hours via the new patient-led model. Without this intervention, these 34% of patients might have faced significant delays or missed the opportunity to receive Ktx due to the lack of clinic involvement during off-hours. Disqualification rates were comparable between the two groups, confirming the safety and effectiveness of the process even when patients initiated the pathway independently from home
Conclusion
This patient-led pathway effectively addressed inequities in access to Ktx for patients treated in ambulatory dialysis clinics. Routine physician assessments during HD ensured consistent clinical readiness, while the structured Transplant Folder enhanced patient autonomy, engagement, communication, and logistic coordination. The model enabled nearly complete transplant execution during off-hours, preventing delays and ensuring equitable access to Ktx. This approach offers a scalable, quality-focused solution to address disparities in transplant delivery