The Variation in Practice of the Living Donor Kidney Transplant Pathway in the UK: Results of a National Survey

Copyright © 2025 Nightingale, Stephenson, Sivaprakasam, Brown, Inston, Hamsho, Ravanan, Nicholson, Asderakis, Browne, Hunter, Marson, Connor, Kelleher, Sutherland, Norton, Maple, Calder, Dor, Barlow, Wijetunga, Youngs, Falconer, Boardman, Smith, Bagul, Sharma, Mehra, Moinuddin, Campbell, van Dellen, Rogers, Burnapp, Haq, Yates, Sinha, Malik, Saif, Gibbs, Khan, Harvitkar, Shrestha, Ghazanfar, Sid. Living donor kidney transplantation (LDKT) accounts for 35% of kidney transplants in the UK. The Organ Donation and Transplantation 2030 initiative underscores the necessity to enhance LDKT rates to meet growing demand. There is limited data on national variations in live donor workup pathways from initial referral to long-term follow-up. We conducted an online survey across all 23 UK transplant centres performing LDKT, covering the entire living donor pathway. We aimed to explore and highlight practice variation and identify opportunities for improvement. Responses were received from 21 centres (91.3%). Marked variation was identified in donor acceptance criteria, including age limits, body mass index thresholds, and donor evaluation timelines (6-36 weeks). Differences were also noted in multidisciplinary team processes, kidney laterality decisions, and perioperative enhanced recovery protocols. All centres used laparoscopic techniques, with hand-assisted transperitoneal nephrectomy being most common (57.1%). Donor nephrectomy and implantation were conducted sequentially in 15 (71.4%) of centres, and in parallel in six (28.6%). Variation was also seen in follow-up duration with 47.6% of centres offering lifelong follow-up. Despite excellent national outcomes, this survey highlights significant variation. Standardising key processes could streamline donor pathways, improve experiences, and support increased LDKT activity in the UK.