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. 2025 Nov 12:38:15341.
doi: 10.3389/ti.2025.15341. eCollection 2025.

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

Katie Nightingale #  1   2 , Josh Stephenson  3 , Rajesh Sivaprakasam  3 , Tim Brown  4 , Nicholas Inston  5 , Ahmed Hamsho  5 , Rommel Ravanan  6 , Michael Nicholson  7 , Argiris Asderakis  8 , Sarah Browne  8 , James Hunter  9 , Lorna P Marson  10 , Katie L Connor  10 , Mortimer Kelleher  10 , Andrew Sutherland  10 , William Norton  11 , Hannah Maple  12 , Francis Calder  12 , Frank J M F Dor  13 , Adam Barlow  14 , Imeshi Wijetunga  2   14 , Rachel Youngs  14 , Stuart Falconer  14 , Victoria Boardman  14 , Matthew Welberry Smith  15 , Atul Bagul  16 , Hemant Sharma  17 , Sanjay Mehra  17 , Zia Moinuddin  2 , Tunde Campbell  2 , David van Dellen  2 , Alistair Rogers  18 , Lisa Burnapp  19 , Kamran Haq  20 , James Yates  21 , Sanjay Sinha  22 , Shahzar Malik  23 , Imran Saif  24 , Paul Gibbs  25 , Kashuf Khan  25 , Rafique Harvitkar  25 , Badri Shrestha  26 , Abbas Ghazanfar  27 , Abul Siddiky  27 , Reza Motallebzadeh  28 , Michael Moneke  7 , Kailash Bhatia #  29 , Titus Augustine #  2   30
Affiliations

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

Katie Nightingale et al. Transpl Int. .

Abstract

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.

Keywords: donor nephrectomy; laparoscopy; living donor kidney transplantation; perioperative care; variation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

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Graphical abstract
FIGURE 1
FIGURE 1
Time and visits required for donor nephrectomy assessment.
FIGURE 2
FIGURE 2
The minimum and maximum accepted age ranges per centre for donor nephrectomy.
FIGURE 3
FIGURE 3
Intra-operative management of renal and lumbar vessels during donor nephrectomy.
FIGURE 4
FIGURE 4
Intra-operative analgesic techniques utilised for donor nephrectomy.
FIGURE 5
FIGURE 5
Postoperative venous thrombo-embolism (VTE) prophylaxis strategies utilised across UK transplant centres.
See this image and copyright information in PMC

References

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