Donor Care Network (DCN) Centers of Excellence are Committed to:

• Only kidney transplant programs with no donor deaths over the prior 10 years are invited to participate in the DCN.
• Only kidney transplant programs with normal complication rates over the prior five years are invited to participate in the DCN.
• Donor surgeons at DCN Centers of Excellence must have completed at least 300 laparoscopic donor nephrectomies, in the aggregate, over the prior five-year period.
• DCN Centers of Excellence must have a laparoscopic procedure utilization rate greater than 95% for nephrectomies over the prior two-year period.

• Provide efficient online donor screening and medical history data collection.
• Email a lab order to the donor to facilitate local pre-workup lab testing at no cost to the potential kidney donor.
• Offer Monday through Friday donor workup appointments to accommodate the donor’s schedule.
• Organize the standard donor workup so it can be completed in one day.
• Provide a dedicated living donor transplant team to support kidney donation.

• Provide laparoscopic nephrectomy including single port, full or hand assisted techniques.
• Proactively let donors know all common pains and problems resulting from kidney donation surgery along with the typical duration of the pain/problem and the best remedies.
• Minimize pain from the donor surgery when medically appropriate by:
  • Utilizing a TAP block.
  • Evacuating as much of the gas as possible before closing.
  • Carefully positioning the donor during surgery to minimize back pain.

• Use IV to deliver pain medication until the donor can manage oral pain medications.
• Promote, encourage, and facilitate walking as soon as possible after surgery.
• Provide a dedicated recovery facility or 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 possible.

• Collaborate with the donor to set a discharge time that meets the needs of the donor.
• Discharge donors within 15 minutes of the promised discharge time.
• Remove all bandages, tape and related markings from donors prior to discharge.
• Call the donor or caretaker within two days after discharge to see how the donor is feeling.
• At the first follow-up appointment (one to two weeks after surgery) run donor labs to ensure there are no abnormalities.
• Provide the ability for donors to utilize local labs for post-surgery follow-ups.

• 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 their hospital check in to avoid carrying personal items around the hospital.

• Provide donor satisfaction surveys to gather feedback throughout the donation process.
• Review donor satisfaction survey feedback and make any appropriate improvements.
• Do not send hospital bills for medical services to donors.
• Do not send solicitations for financial donations to donors.

DCN Centers of Excellence are committed to sharing and adopting best practices that will improve the donation process such as:

• What is the best approach for post-surgery pain medication that minimizes donor pain and 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 and from being sent fundraising solicitations?
• What is the best way to organize the basic workup (guide, map, schedule, transportation, etc.)?
• What is the best way to proactively predict an increased risk of donor complications or poor outcomes?
• What has the most impact on the donor’s perception of a positive donation experience?
• What is the best way to get candid and actionable feedback from donors?

• Achieve NKR Partner Center status.
• Offer all donors the option to utilize the Donor Connect service.
• Provide Donor Shield protections and support for all donors (through the KFL expert system or Donor Shield Direct).
• Utilize the DASH automated donor follow-up to maximize donor convenience.
• Utilize the DASH intake system for all donors to maximize donor convenience.

• Assign a guide to accompany the donor during the workup 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 or validate donor and caretaker parking.
• Provide car service for donor travel to and from the center.
• Offer Monday through Saturday workup appointments.
• Provide a donor reception area that is clearly marked and easy to find.
• Reduce the number of different employees that interface with donors to <5.
• Provide timely email updates to the donor throughout the entire donation process.
• Provide urologist style bathrooms for convenient urine specimen collection so that donor’s do not need to carry around urine samples.
• Create a dedicated streamlined donor clinic (see example).
• Provide chairs in the recovery area outside the operating room 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
  • Donor surgery complication rate
  • Other information relevant to donors
• Minimize back pain
  • Offer manual physical therapy to donors experiencing back pain after surgery.
  • Utilize recovery beds that minimize back pain.
• Free Wi-Fi high speed internet.
• Provide inpatient rooms with:
  • Private bathroom.
  • Private shower.
  • Room service so that caretakers do not need to leave the 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/luggage 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 the car ride home.