Quality statement 3: Transplantation – on dialysis

Quality statement

Adults on dialysis are offered a kidney transplant, if they are medically suitable.

Rationale

Transplant survival has been shown to be negatively influenced by the duration of dialysis before transplantation. Therefore, it is important that adults who are on dialysis continue to be supported to receive a kidney transplant if it is medically suitable for them. This includes adults for whom pre‑emptive transplantation was not possible and also those starting dialysis in an unplanned way.

Quality measures

Structure

a) Evidence of local arrangements to ensure that adults on dialysis have their suitability for kidney transplantation assessed at the earliest opportunity.

Data source: Local data collection.

b) Evidence of local arrangements to ensure that adults on dialysis receive a kidney transplant, if they are medically suitable.

Data source: Local data collection.

Process

a) Proportion of adults receiving dialysis that was started in a planned way (excluding those presenting late in advanced chronic kidney disease) who are medically suitable and active on the kidney transplant waiting list within 6 months of starting dialysis.

Numerator – the number in the denominator active on the kidney transplant waiting list within 6 months of starting dialysis.

Denominator – the number of adults receiving dialysis that was started in a planned way who are medically suitable for kidney transplantation.

b) Proportion of adults receiving dialysis that was started in an unplanned way who are medically suitable and active on the kidney transplant waiting list within 12 months of starting dialysis.

Numerator – the number in the denominator active on the kidney transplant waiting list within 12 months of starting dialysis.

Denominator – the number of adults receiving dialysis that was started in an unplanned way who are medically suitable for kidney transplantation.

Data source: Local data collection.

c) Proportion of adults previously or currently on dialysis who are medically suitable for, and who receive, a kidney transplant.

Numerator – the number in the denominator who receive a kidney transplant.

Denominator – the number of adults previously or currently on dialysis, who are medically suitable for a kidney transplant.

Data source: NHS Digital's Hospital Episode Statistics contains data on kidney transplantation.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (specialist renal centres) ensure that they offer a kidney transplant to adults on dialysis, if they are medically suitable.

Healthcare professionals ensure that they assess adults on dialysis for kidney transplant suitability and offer a transplant to adults, if they are medically suitable.

Commissioners (NHS England area teams) ensure that they commission services that offer adults on dialysis a kidney transplant, if they are medically suitable.

What the quality statement means for patients, service users and carers

Adults who are already on dialysis are offered a kidney transplant as soon as possible, if it is a suitable treatment for them.

Source guidance

Renal replacement therapy and conservative management (2018) NICE guideline NG107, recommendations 1.3.3, 1.3.4, 1.3.5 and 1.3.6