Dr Tess Cooper1, Ms Tennille Vitagliano1, Prof Kate Wyburn1,3, Dr Melanie Wyld1,2
1University of Sydney, Camperdown, Australia, 2Department of Renal and Transplantation, Westmead Hospital , Westmead, Australia, 3Department of Renal and Transplantation, RPA Hospital , Camperdown, Australia
Biography:
Melanie Wyld (B.Econ(Hons) MBBS MBA MPH PhD FRACP) is a nephrologist at Westmead Hospital and senior lecturer in clinical epidemiology at the School of Public Health, Faculty of Medicine and Health, University of Sydney. She received her PhD ‘Health outcomes and cost-effectiveness in kidney disease’ in 2019 from the University of Sydney. She is a clinical researcher with research interests in living donor kidney transplantation and equity of access to care. She is the Chair of Equity Diversity and Inclusion Committee of ANZSN, Chair of TSANZ’s Living Donor Transplantation Working Group, and Chair of ANZDATA’s Living Donor Working Group.
Background:
Living donor kidney transplantation provides superior patient and graft outcomes compared to deceased donor transplantation yet remains underutilised globally. A key barrier is recipient discomfort with current care models that rely heavily on recipient-led solicitation. Optimal solicitation models are unknown.
Aim:
To evaluate the effectiveness of interventions designed to support living donor solicitation, and to assess the quality and certainty of the existing evidence base.
Methods:
This systematic review and meta-analysis followed standard Cochrane methodology. We searched 4 databases and grey literature from inception to 22 May 2024 for randomised controlled trials (RCTs) and non-randomised intervention studies evaluating living donor solicitation strategies. We performed meta-analyses, separating RCTs and non-randomised evidence, and used the Grading of Recommendation, Assessment, Development, and Evaluation approach to assess our certainty in the evidence.
Results:
We included 22 RCTs (27082 participants) and 7 non-randomised interventions (2193 participants) aimed at promoting living donor solicitation. Education programs increased enquires (Relative Risk (RR)1.65, 95%CI 1.10, 2.46), solicitation (RR1.86, 95%CI 1.02, 3.40), and transplants (RR4.01, 95%CI 1.49, 10.76) compared to usual care (very low certainty evidence). One-on-one versus group education had uncertain effects on enquiries (RR1.51, 95%CI 0.91, 2.51), and transplants (RR1.69, 95%CI 1.17, 2.45) (very low certainty evidence).
Conclusion:
Education programs can improve living donor enquiry, solicitation, and transplantation rates. However, the evidence base is limited by very low certainty and high risk of bias. High-quality RCTs using standardised outcomes are urgently needed to improve solicitation strategies and access to LDKT.
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