436 Barriers for Cadaveric Kidney Organ Utilisation: Results of a National Transplant Access to Theatre (NTACT) Pilot Study

Abstract

Abstract Background There are various barriers to cadaveric organ utilisation across the UK. However, there is a paucity of data on the barriers after the arrival of organ/s at the implanting centre. We set up the national “NTACT” study to identify barriers after arrival of organs at implanting centre. Method Prospective pilot study collecting data on adult kidney/pancreas cadaveric organs across five UK transplant centres in July 2021. Data collected includes time intervals between significant checkpoints prior to transplantation and perceived reasons for delays after arrival at implanting centre. Data was recorded on RedCap and analysed for delays using descriptive statistics. Results Between five transplant centres, data was entered on 27 transplants. Five patients were excluded from the study (live transplant-2, incomplete data-3). There were six donations after circulatory death (DCD) and 16 donations after brainstem death (DBD) organs. Fifty percent (n=3/6) of DCD and 12.5% (n=2/16) of DBD allografts surpassed the national recommendations for CIT. The majority of crossmatches were virtual (15 virtual and seven full). Delays included crossmatch results (median=03:37:30), time between the arrival of the kidney and patient into theatre (median=03:13:00), time between anaesthetic induction and knife to skin (median=00:52:00). The median warm ischaemia time was 00:41:30 (IQR-00:33:00–00:49:30). Qualitative answers highlight themes: “surgical team occupied in another case”, “emergency theatre occupied”, “porter availability for transporting patients”. Discussion Our pilot study identified various barriers to implantation, and a significant proportion of kidneys are implanted beyond nationally accepted CIT. Further work is required to get a national picture over an extended period.