American Journal of Kidney Diseases

The Adoption of a One-Day Donor Assessment Model in a Living Kidney Donor Transplant Program: A Quality Improvement Project

Published:November 14, 2017DOI:


      Survival of kidney transplants and their recipients is significantly better after living donor than after deceased donor transplantation. However, historically, Northern Ireland has had a low rate of living donor kidney transplantation. The length and complexity of donor evaluation has been one of the main factors contributing to this pattern.

      Study Design

      Quality improvement project.

      Settings & Participants

      All people in Northern Ireland expressing an interest in becoming a living kidney donor between 2010 and 2015.

      Quality Improvement Intervention

      Potential donors deemed to be suitable after a screening questionnaire attended a comprehensive 1-day evaluation including all investigations that had been previously been implemented across multiple clinical visits.


      Change in rate of living donor transplantation following the quality improvement intervention.


      Demographic data and reasons for nondonation.


      431 potential donors underwent a 1-day assessment, with 284 (66%) ultimately donating and 12 (3%) still active in the program. Of the 135 (31%) potential donors who did not donate, 48 were unsuitable due to medical or surgical issues, 2 became pregnant, and 18 withdrew. For 38 (9%) potential donors, intended recipients found an alternative living or deceased donor transplant. For 29 (6%) potential donors, the transplantation did not proceed because of recipient-related issues. The annual rate of living donor kidney transplantation in Northern Ireland increased from a mean of 4.3 per million population (pmp) between 2000 and 2009 to 32.6 pmp between 2011 and 2015.


      Single geographical region with a potentially unrepresentative population and health care organization. Retrospective observational study. Paucity of data from the preintervention period.


      Following implementation of a 1-day assessment process, we observed a considerable and sustained increase in the rate of living donor kidney transplantation. Making donor evaluation easier holds promise to increase the number of living donor kidney transplants, potentially optimizing outcomes for both recipients and donors.

      Index Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Kidney Diseases
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Tonelli M.
        • Wiebe N.
        • Knoll G.
        • et al.
        Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes.
        Am J Transplant. 2011; 11: 2093-2109
        • Laupacis A.
        • Keown P.
        • Pus N.
        • et al.
        A study of the quality of life and cost-utility of kidney transplantation.
        Kidney Int. 1996; 50: 235-242
        • Legendre C.
        • Canaud G.
        • Martinez F.
        Factors influencing long-term outcome after kidney transplantation.
        Transpl Int. 2014; 27: 19-27
        • Terasaki P.I.
        • Cecka J.M.
        • Gjertson D.W.
        • Takemoto S.
        High survival rates of kidney transplants from spousal and living unrelated donors.
        N Engl J Med. 1995; 333: 333-336
        • Reese P.P.
        • Caplan A.L.
        • Kesselheim A.S.
        • Bloom R.D.
        Creating a medical, ethical and legal framework for complex living kidney donors.
        Clin J Am Soc Nephrol. 2006; 1: 1148-1153
      1. British Transplantation Society. United Kingdom Guidelines for Living Donor Kidney Transplantation. 3rd ed. May 2011. Accessed June 7, 2017.

        • European Directorate for the Quality of Medicines & HealthCare of the Council of Europe
        Newsletter transplant international figures on donation and transplantation 2015.
        EDQM. 2016; 21 (Accessed May 11, 2017): 6
        • Arunachalam C.
        • Garrues M.
        • Biggins F.
        • Woywodt A.
        • Ahmed A.
        Assessment of living kidney donors and adherence to national live donor guidelines in the UK.
        Nephrol Dial Transplant. 2013; 28: 1952-1960
        • Lapasia J.B.
        • Kong S.Y.
        • Busque S.
        • Scandling J.D.
        • Chertow G.M.
        • Tan J.C.
        Living donor evaluation and exclusion: the Stanford experience.
        Clin Transplant. 2011; 25: 697-704
        • McCurdie F.J.
        • Pascoe M.D.
        • Broomberg C.J.
        • Khan D.
        Outcome of assessment of potential donors for live donor kidney transplants.
        Transplant Proc. 2005; 37: 605-606
        • Young A.
        • Karpinkski M.
        • Treveaven D.
        • et al.
        Differences in tolerance for health risk to the living donor among potential donors, recipients and transplant professionals.
        Kidney Int. 2008; 73: 1159-1166
        • Maple N.H.
        • Hadjianastassiou V.
        • Jones R.
        • et al.
        Understanding risk in living kidney donor nephrectomy.
        J Med Ethics. 2010; 36: 142-147
        • Grams M.E.
        • Sang Y.
        • Levey A.S.
        • et al.
        Chronic Kidney Disease Prognosis Consortium. Kidney-failure risk projection for the living kidney-donor candidate.
        N Engl J Med. 2016; 374: 411-421
      2. Organ Donation Transplant Ireland. Organ Donation and Transplant Ireland Annual Report 2014. Accessed May 11, 2017.