J. Chen1, J. Hiller1, W. Zhang2, A. Massie1,2, K. Covarrubias1, K. Jackson1, J. Long1, S. DiBrito1,2, D. Segev1,2, J. Garonzik-Wang1 2Johns Hopkins School of Public Health,Department Of Epidemiology,Baltimore, MD, USA 1Johns Hopkins University School of Medicine,Department Of Surgery,Baltimore, MD, USA
Introduction: Over the past fifteen years, the number of inactive candidates on the kidney transplant waitlist has grown substantially, resulting in a large pool of candidates that transplant centers monitor for appropriate conversion to active status. Management of these patients has become an increasingly complex administrative undertaking. We sought to examine waitlist management strategies at transplant centers across the United States to inform understanding of how centers approach and manage the inactive waitlist.
Methods: Transplant centers with an active kidney program were identified through the national Organ Procurement and Transplantation Network (OPTN). We obtained contact information of the team member(s) responsible for waitlist management at each center via phone or email. Surveys were distributed electronically using Qualtrics software from April to November 2018. Descriptive statistics of the transplant centers’ characteristics were computed and visually displayed.
Results: We obtained contact information for 247/306 (80%) active kidney transplant centers, and a total of 82/247 (33%) centers responded to our survey. Centers reported a median of 5 (IQR 3, 8) pre-transplant coordinators and assistants. There were 33 centers (40%) who reported having 201-500 candidates on their waitlist, and 44 (54%) reported 21-40% of their waitlist consisted of inactive candidates. Of respondents, 38 centers (46%) lacked specific time frames for candidates to complete pre-transplant testing, and 34 (41%) did not have scheduled review of inactive candidates’ statuses. Centers differed in their tendencies to list candidates as inactive. (Figure 1) While 24 centers (29%) used EMRs and transplant databases for reminders to review candidate status, 28 (34%) relied on spreadsheets or coordinator memory. A multidisciplinary approach to candidate status review was utilized by 24 centers (29%), while 9 (11%) employed strategies to minimize unnecessary reviews, such as prioritizing candidates most likely to receive an offer. When asked how long it took for an inactive candidate to return to active status, 29 centers (35%) did not know. When rating their approach to managing the inactive waitlist, 35 centers (43%) thought their approach was excellent or satisfactory while 47 (57%) felt there was a need for improvement.
Conclusion: Centers use a range of strategies to manage the inactive waitlist. The results of this survey demonstrate the need for the establishment of best practices for the efficient management of the inactive candidates to promote a prompt return to active status.
