Virtual Kidney Transplant Evaluation Helps Maintain Access During COVID-19

By Lisa Rapaport

January 25, 2021

(Reuters Health) - A virtual system to evaluate and waitlist patients for kidney transplants may help maintain access to care even when in-person visits are limited due to the COVID-19 pandemic, a recent study suggests.

Researchers assessed the effectiveness of a telemedicine program established during the COVID-19 pandemic, comparing operational metrics for the kidney transplantation program from April to September 2020 to the same period in 2019.

During the 2020 study period, there were a total of 1,148 referrals for kidney transplant evaluation, compared with 1,639 during the 2019 study period. Despite this roughly 30% decline in referrals, more patients completed evaluations in 2020 (930) than in 2019 (880).

With telemedicine transplant evaluations, there was no sharp decline in the total number of patients ultimately added to the waiting list in 2020 (282) compared with 2019 (308), the study also found.

"There are multitude of factors affecting evaluation of the patients for transplantation including patients' age, race, education, socioeconomic status, rural vs. urban, distance from the transplant centers, and logistics of getting the patients to the hospital for evaluation," said lead study author Dr. Vinayak Rohan of the division of transplant surgery at the Medical University of South Carolina in Charleston.

"With the virtual evaluation we are taking the transplant program to patients' doorstep, overcoming many of the above stated hurdles," Dr. Rohan said by email.

Once the pandemic limited access to in-person visits for transplant evaluation, a team of surgeons, nephrologists, advanced practice practitioners, social workers and other members of the surgical quality improvement program implemented telemedicine assessments.

Patients were prioritized for virtual evaluations based on a set of criteria focused on how much workup or testing was expected to be necessary to identify transplant candidates.

The first, or "red," group included patients whose age or medical condition made it unlikely they would end up being candidates for transplantation and therefore require a full presurgical evaluation. Patients in this group were over age 70 and had a history of stroke, significant cardiac or peripheral vascular disease, or poor functional status.

The second, or "green," group included patients who were likely to be candidates for transplantation and placed on the wait list for a donated organ. Patients in this group were under 45 years of age and had no history of diabetes.

The third group, or "yellow," group included "fast track" patients as well as all other patients. "Fast track" patients were on the wait list at another transplantation center and required minimum further workup.

Then, virtual assessments were scheduled and reviewed based on these categories, with "fast-track" patients expedited first, followed by patients in the "red" and "green" groups.

Before the telemedicine visits, a member of the evaluation team reached out to patients or family members to ensure that they had a smartphone or tablet available to use for assessments and answer any questions about how the technology would be used.

One limitation of these virtual evaluations is that some patients were unable to manage the technology, had unreliable internet connections, or challenges engaging with providers via the telehealth platform, the study team notes in the Journal of the American College of Surgeons.

"We do need to ensure equal access to any telehealth platform and continue to provide in person alternatives, if needed," said Amy Waterman, a professor of medicine at the University of California Los Angeles and deputy director of the Terasaki Institute for Biomedical Innovation.

"Patients must have phones allowing video conferencing and sufficient internet bandwidth access to allow for telehealth evaluation to occur," Waterman, who wasn't involved in the study, said by email. "If we don't do this, the disparities in access to wait-listing might become worse."

SOURCE: Journal of the American College of Surgeons, online December 21, 2020.