SP3.4 Barriers to deceased donor kidney organ utilisation: Results of a National Transplant ACcess to Theatre (NTACT) Audit

Abstract

Abstract Aims Various barriers to deceased-donor kidney utilisation exist, however, there is a lack of data on these; therefore, this national audit aims to identify the barriers to prompt kidney utilisation after the arrival of organs at the implanting centre (IC). Methods We conducted a multicentre, prospective audit of adult deceased-donor kidney-only transplants across 14 UK centres between February and September 2022. Data was collected on time-intervals between significant checkpoints before transplantation and perceived reasons for delays. Data was recorded on RedCap and analysed using descriptive statistics. Results 476 kidney-only transplants were recorded (59 excluded-incomplete/incorrect data). There were 215 donations after brainstem death (DBD) organs and 202 donation after circulatory death (DCD) organs. The median cold ischaemia time (CIT) for DBD organs was 10:51 (IQR: 08:07-14:44), and for DCD organs was 11:09 (IQR: 08:13-14:50). The national CIT recommendations were exceeded by 40% of DCD and 14% of DBD organs. The median time-interval between the organ’s arrival at IC and knife-to-skin was 04:16 (IQR 02:46-07:52). The median time-interval between anaesthetic induction and knife-to-skin was 00:55 (IQR: 00:39-01:10). In 17% of cases, crossmatch results arrived after organ arrival at IC, median delay was 02:30 (IQR: 00:56-04:27). Delays were reported in 34% of cases, availability of the surgical team, anaesthetic team, porters, and the operating theatre were the most common causes of delay. Conclusions A significant proportion of kidneys were implanted beyond nationally recommended CIT. This audit delineated the current timings of each stage of the transplantation process and will be used in future to set realistic targets to optimise current practice.