Quality standard
Quality statement 2: Transplantation – pre‑emptive
Quality statement 2: Transplantation – pre‑emptive
Quality statement
Adults who will need renal replacement therapy are offered a pre‑emptive kidney transplant, if they are medically suitable.
Rationale
Evidence shows that transplant outcomes are better for adults who have not been on dialysis (that is, pre‑emptive transplantation) than those who have, and that transplant survival is negatively influenced by the duration of conventional dialysis before transplantation.
It is recommended that adults with progressive deterioration in kidney function for whom transplantation is an option should be placed on the national transplant list within 6 months of their anticipated dialysis start date. Pre‑emptive transplantation should be considered as the treatment of choice for all suitable patients when a living donor is ideally available because this provides most people with the best chance of long‑term rehabilitation.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
a) Evidence of local arrangements to ensure that adults who will need renal replacement therapy have their suitability for kidney transplantation assessed at the earliest opportunity.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from local service specifications with written criteria for assessment.
b) Evidence of local arrangements to ensure that adults who will need renal replacement therapy receive a pre‑emptive kidney transplant, if they are medically suitable.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from local service specifications.
Process
a) Proportion of adults who will need renal replacement therapy who are assessed for transplant suitability.
Numerator – the number in the denominator who are assessed for transplant suitability.
Denominator – the number of adults who will need renal replacement therapy.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
b) Proportion of adults who will need renal replacement therapy and are medically suitable for pre‑emptive kidney transplantation, who receive a pre‑emptive kidney transplant.
Numerator – the number in the denominator receiving a pre‑emptive kidney transplant.
Denominator – the number of adults who will need renal replacement therapy and are medically suitable for pre‑emptive kidney transplantation.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
What the quality statement means for different audiences
Service providers (such as hospitals and specialist renal centres) work together to ensure that adults who will need renal replacement therapy are offered pre‑emptive kidney transplantation if they are medically suitable.
Healthcare professionals (such as nephrologists, transplant surgeons, renal nurses, specialist transplant nurses and renal transplant coordinators) ensure that they assess adults who will need renal replacement therapy for transplant suitability, and offer pre‑emptive kidney transplantation to adults who are medically suitable.
Commissioners ensure that they work together to commission services for adults who will need renal replacement therapy and are medically suitable for transplantation to receive pre‑emptive kidney transplantation.
Adults who have kidney failure are offered a kidney transplant, if it is a suitable treatment for them, before they need to start dialysis. Kidney transplant involves replacing a kidney with one from a person who has recently died or from a relative.
Source guidance
Renal replacement therapy and conservative management. NICE guideline NG107 (2018), recommendation 1.3.6
Definitions of terms used in this quality statement
Pre‑emptive transplantation
Pre‑emptive kidney transplantation is carried out for adults who are medically suitable before dialysis is needed. A kidney may be used from a living or deceased donor, although a living donor is preferred. [Adapted from NICE's guideline on renal replacement therapy and conservative management, recommendation 1.3.6]