ABSTRACT
Purpose: Individuals considering living kidney donation face geographic, financial, and logistical challenges. Telemedicine has the potential to facilitate care delivery/ coordination for donors. We aimed to understand center practices and provider attitudes and perceived barriers of telemedicine services for living kidney donation. Method(s): We conducted a national survey of multidisciplinary providers from 194 U.S. active adult living donor kidney transplant centers in 2020. The survey was distributed with an online link from 2/18/2021 to 5/13/2021, and up to two reminders were provided. The target population included nephrologists, surgeons, nurse coordinators, social workers or independent living donor advocates, and psychiatrists or psychologists. We used descriptive statistics and analysis of variance. Result(s): Two hundred ninety-three providers from 128 unique centers responded to the survey, a center representation rate of 66.0%, reflecting 82.9% of U.S. practice by donor volume and 91.5% of U.S. states/territories. Most centers (70.3%) will continue using telemedicine beyond the COVID-19 pandemic. Video only was mostly used for donor evaluation by nephrologists, surgeons, psychiatrists or psychologists. Telephone and video were mostly used by social workers, while no mutual modality was used by coordinators. Vital signs and weight were obtained largely using self-reported measures or a local provider/primary care physician, and a physical exam was mostly completed at a subsequent in-person visit to the transplant center. Providers strongly agreed that telemedicine was convenient for donors and would improve the likelihood of completing donor evaluation for potential donors. These attitudes were consistent across provider roles (p>0.05). Providers were favorably disposed to use telemedicine beyond the pandemic for donor evaluation and followup care. Out-of-state licensing and reimbursements were key regulatory barriers. Conclusion(s): These findings help inform clinical practice and policy expanding telemedicine services to enhance access to living donation and may be extended to other medical specialties.
ABSTRACT
Introduction: Kidney transplant (KT) recipients with COVID-19 symptoms are bringing challenges to providers given the risk of COVID-19 exposure to health care workers, patients, and the public. Case Description: Three KT recipients with COVID-19 were managed using telemedicine via synchronous video visits integrated with an electronic medical records system, from home to inpatient settings (Figure 1-2). Patient 1 is a 53-year-old male s/p KT in 2012;Patient 2 is a 56-year-old female s/p KT in 2019;and Patient 3 is a 53-yearold female s/p simultaneous liver-kidney transplant in 2014. Patients 1 and 3 had followup COVID-19 NAT testing: Patient 1 converted to be negative at 24 & 28 days, whereas Patient 2 converted to be negative at 45 & 48 days. Discussion: Telemedicine helped assess, diagnose, triage, and treat patients with COVID-19 while avoiding an ER or outpatient clinic visit. We highlight the value of telemedicine in the maintenance of uninterrupted follow-up care for immunosupressed patients with prolong viral shedding.