Donor Care Network 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 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 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.
• Offer the option to ship the 24-hour urine collection container to donor’s home.
• Offer the option to perform pre-workup lab testing at a lab near the donor’s home.
• 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 easy to understand informed consent documents, including living donor transplant prioritization if involved in an NKR swap, Voucher programs, and Donor Shield protections.
• 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 medication.
• Promote, encourage, and facilitate walking as soon as appropriate 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.
• Support lifetime donor follow-up for donor monitoring and research (piloting).

• 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.
• Do not send hospital bills for medical services to donors.
• Do not send solicitations for financial donations to donors.

Donor Care Network Centers of Excellence 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 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 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 fund raising solicitations?
• What is the best way to organize the basic workup (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 a positive donation experience?
• What is the best way to get candid and actionable feedback from donors?

• Achieve National Kidney Registry Partner Center status.
• Participate in the NKR’s Family Voucher Program.
• Participate in the NKR’s remote donation network.
• Provide Donor Shield protections for all donors.

• 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.