Sharing regional capacity in deceased donor kidney transplantation: experience from a regional collaborative in a metropolitan area.

Background: Access to deceased donor kidney transplantation may be restricted in the event of resource limitation induced by extreme peaks in activity or local major incidents, which exceed centre capacity. An organ-sharing protocol was developed by the five London transplant units in 2019 to establish a system for safe transfer of organs and recipients between five regional kidney transplant units. We describe the activity and outcomes over the initial 20-month period. Methods: National data on kidney transplants performed via the collaborative scheme were obtained from National Health Service Blood and Transplant. Outcomes data was collected locally and analysed. Results: Sixteen recipients were transplanted between November 2020 and July 2022. The reasons for referral were theatre capacity and an information technology systems failure. Donor kidneys were from 10 brainstem death donors (62.5%) and six circulatory death donors (37.5%). Half of the donors fulfilled standard criteria. Twelve patients (75%) were first transplant recipients. Three (18.75%) were highly sensitized (calculated reaction frequency ≥85%). Three (18.75%) patients required arterial reconstruction. Seven patients (43.75%) had delayed graft function. Median creatinine at 12 months post-transplantation was 134 µmol/L. The median length of stay was 7.5 days. Three recipients (18.75%) died within the first year, two from SARS-CoV-2 infection. Conclusions: This unique organ sharing collaborative scheme involving five hospitals in London enabled 16 transplants to proceed which otherwise would not have occurred. Although initially established for low-risk donors and recipients, the scheme has evolved to enable transplantation for a wide variety of recipients of varying complexity.