Donor Care Network Centers of Excellence are Committed to:
Eliminate the risk of a donor death and minimize complications
- Only kidney transplant programs with no donor deaths over the prior ten years are invited to participate in the Donor Care Network (DCN) unless a root cause and corrective action plan is accepted by the DCN.
- Only kidney transplant programs with normal complication rates over the prior five years are invited to participate in the DCN unless a root cause and corrective action plan is accepted by the DCN.
- Donor surgeons at the DCN Centers of Excellence (Centers) must have completed at least 300 laparoscopic donor nephrectomies, in the aggregate, for the prior five year period.
- DCN Centers must have a laparoscopic procedure utilization rate greater than 95% for nephrectomies completed for the prior two year period.
Make the donor intake process as easy as possible
- Provide online donor screening and medical history data collection.
- Provide a dedicated living donor transplant team to support kidney donation.
- Present easy to understand educational materials supported by published research.
- Offer the option to ship the 24-hour urine collection container to donor’s home or office.
- Offer Monday through Friday donor work-up appointments to accommodate the donor’s schedule.
- Organize the standard donor work-up so it can be completed in one day.
- Provide clear and easy to understand informed consent documents including protections offered to all donors involved in NKR swaps such as disability insurance, life insurance, prioritization for a living donor kidney, etc.
Make the donor surgery as easy and as safe as possible
- Provide laparoscopic nephrectomy including single port, full or hand assisted techniques.
- Proactively let donors know all common pains and problems, the remedies and typical duration.
- Minimize donor pain from the donor surgery when medically appropriate by:
- Utilizing a TAP block.
- Evacuating as much of the gas as possible before closing.
- Careful positioning during surgery to minimize back pain.
Make the donor recovery as easy and as safe as possible
- Use IV to deliver pain medication until the donor is capable of managing oral pain medication.
- Promote, encourage, and facilitate early activity (e.g., walking).
- Provide a dedicated recovery facility/transplant floor for kidney donors and recipients.
- Provide donors and caretakers with a recovery plan explaining what the donor must do before:
- The urinary catheter can be removed.
- The IV can be disconnected.
- The donor can be discharged.
- The recovery plan should include approximate time frames for each step of the recovery process.
- Minimize extraneous tape/bandages and remove them from the donor as soon as feasible.
Make the donor hospital discharge and follow-up as easy as possible
- Collaborate with the donor to set a discharge time that meets their needs and expectations.
- Remove all bandages, tape and related markings from donors prior to discharge.
- Discharge donors within 15 minutes of the promised discharge time.
- Call the donor or caretaker within 2 days of discharge to see how the donor is feeling.
- At the first follow-up appointment (1-2 weeks) donor labs should be performed to ensure there are no post-donation medical abnormalities.
- Provide ability for donor to utilize local lab for follow-up.
- Support lifetime donor follow-up for data collection and donor feedback (piloting).
Make the process as easy as possible for the donor’s caretaker
- Provide comfortable sleeping accommodations for caretakers in the patient’s room.
- Provide timely updates to caretakers throughout the surgery and recovery process.
- Provide a convenient and secure method for patients and caretakers to store personal belongings after hospital check in to avoid carrying items around the hospital.
Treat donors and their caretakers with courtesy and respect
- Provide donor satisfaction surveys to gather feedback throughout the donation process.
- Do not send hospital bills for medical services to donors.
- Do not send solicitations for financial donations to donors.
Share and adopt best practices
DCN Centers are committed to sharing and adopting best practices that will improve the donation process. Conference calls are organized periodically, along with informal communications, to discuss the more challenging and controversial topics that benefit from multiple perspectives. Examples of these topics include:
- What is the best approach for post-surgery pain medication that minimizes donor pain but maximizes speed of recovery?
- What is the best way to determine the discharge date/time?
- What is the best way to assist donors with pain and problem remedies after discharge?
- What is the best physical organization of the donor clinic?
- What is the best way to maximize caretaker comfort and convenience?
- What is the best way to consistently prevent the donor from being billed?
- What is the best way to organize the basic work-up (guide, map, schedule, transportation, etc.)?
- Is there a way to eliminate the need for potential donors to lug around a 24-hour urine collection jug?
- What is the best way to proactively predict an increased risk of donor complication or donor death?
- What has the most impact on the donor’s perception of the donation experience?
- What is the best way to get candid and actionable feedback from donors?
Other DCN Center requirements
- Achieve NKR Partner Center status.
- Provide remote workup and donation services.
- Provide Donor Shield protections.
- Executed NKR donor protection addendum.
- Provide online donor screening and medical history data collection.
- Ship 24-hour urine jugs to donor’s home as a courtesy.
- Provide pre-workup lab testing at a lab near the donor’s home.
- Assign a guide to accompany the donor at all times during the work-up and pre-op visits.
- Provide a 3D picture/map and clear directions for donor movement within the hospital.
- Offer valet parking for donor and caretaker.
- Pay for donor and caretaker parking (validate).
- Provide car service for donor travel to and from the Center.
- Offer Monday through Saturday work-up appointments.
- Donor reception area clearly marked and easy to find.
- Minimize the number of different employees that interface with donors.
- Provide timely email updates to the donor throughout the entire donation process.
- Provide urologist style bathrooms for convenient urine specimen collection.
- Create a dedicated streamlined donor clinic (see example).
- Provide chairs in the recovery area outside the OR so that caretakers can sit down.
- Provide donor surgeon(s) profile and performance statistics:
- Laparoscopic nephrectomy performed supporting kidney donation
- Percent of donor surgeries that were laparoscopic
- Complication rate
- Other information relevant to donors
- Offer manual physical therapy to donors experiencing back pain from surgery.
- Utilize recovery beds that minimize back pain.
- Free Wi-Fi high speed internet.
- Provide private inpatient rooms with:
- Ensuite bathroom.
- Room service so that caretakers do not need to leave the inpatient room for meals.
- Assign only one nurse per shift to support a donor after surgery.
- Minimize the number and frequency of hospital staff entering the inpatient room.
- Provide a TV in the donor’s inpatient room.
- Utilize private in-patient rooms as a waiting/staging area for donors and caretakers prior to surgery.
- Provide a comprehensive discharge care package that includes:
- BP monitor.
- Appropriate OTC medications (e.g., Maalox, Gas-X, Tylenol, etc.).
- After care brochure/instructions.
- Pillow to place over incision for ride home.