Program interventions to build access to living donor transplantation

Purpose of review – Living donor transplantation is the optimal treatment for end-stage renal disease and end-stage liver disease. For the recipient, the benefits of living donation include improved duration of graft survival compared to deceased donation and avoidance of lengthy waiting time and risks of dialysis. For transplant centers, a robust living donor program results in consistent transplant case volumes, daytime cases and a decreased reliance on potentially unfavorable allocation policy changes. Transplant programs require a playbook of actionable initiatives based on consensus best practices and peer-reviewed data to optimize opportunities to increase living donor evaluation and surgery within current legal and policy frameworks. Relevant findings – Strategies to increase center living donor volume include utilization of culturally competent transplant education and outreach, development of living donor champion programs, wider utilization of financial assistance programs available to living donors, increased enrollment in paired donor exchange services and adaptation of modern evidence-based selection and evaluation criteria. Summary – Understanding the current landscape of living donor transplantation and exploring areas of innovation is imperative to a center's ability to continue to serve the full spectrum of patients with end stage organ disease to the best of our collective ability.