Also, kidney allocation has changed recently, he says. "In the past, your clock started ticking when you were referred to the transplant center and they put you on the list. Now, your clock starts from when you started on dialysis." A better list-management strategy for kidney is to evaluate the patients, manage the condition, and defer listing them until they are closer to requiring transplantation. "That makes the list size smaller, your transplant rate higher, and your costs go down because you're not spending as much on testing people who are not going to be transplanted right away." The same strategy can be applied to liver transplants, adds Kinkhabwala.
Success key No. 4: Have an innovative donor strategy
Despite the advances in transplantation, the reality is more than 77,000 people are active waiting list candidates for an organ transplant, according to UNOS. One way to reduce this list is by expanding organ procurement methods, including expanding living donor programs.
Tim Taber, MD, a transplant nephrologist and medical director of kidney and pancreas transplantation for Indiana University Health and the chief medical officer for Indiana Donor Network, says IU Health Transplant has deployed several strategies to bring in more donors. To start, he says, it is critical to be willing to travel.
"We have built a reputation for having physicians who are willing to travel to hospitals across the country at any time of the day or night to take a closer look at donor organs to see if they could be suitable for a transplant back in Indiana," says Taber. "Doing so gives our doctors access to more organs to consider for patients."
IU Health Transplant performed 145 liver transplants, 177 kidney transplants, and 26 pancreas transplants in 2015, according to the OPTN. Taber, who works with a team of nearly 100 clinicians and specialists, says that it is important to examine every organ. "IU transplant surgeons review each organ individually, which means we are able to use more organs and significantly reduce wait times."
His top goal this year is to expand the kidney living donor program at IU Health Transplant. He says about one-third of all kidney donors at IU Health Transplant are living. To increase this percentage, he says, IU Health Transplant has also been doing paired donations for several years. The paired donation process works to procure a living donor for individuals who have a living donor who isn't a match.
IU has also started a donor champion program that helps potential recipients find a donor and teaches them how to talk to people about donations. "The other thing we're doing is trying to do a better job using kidneys that are on the margin of what we've used before and trying to push the boundaries of the quality of kidneys we've taken in the past," says Taber. "Nationally, we just haven't done a good enough job of that. A lot of kidneys are turned away that are procured that probably could be used in the appropriate circumstances."