“Because of the distance she would have had to travel for an evaluation, we really felt that it was asking way too much,” said Dr. Thomas McCune, the kidney recipient's nephrologist and medical director of the pancreas transplant program at Sentara Norfolk General. The care team started connecting with the donor late last year; the transplant was initially scheduled for March, but was delayed to August due to COVID-19.
It’s not the first time Sentara’s transplant team has allowed remote work-ups and evaluations of a living kidney donor, but it is the first time it’s been done with a donor outside of the U.S.
The donor eventually traveled the more than 8,000 miles to Norfolk about two weeks before the scheduled procedure in August, so the transplant team could complete a psycho-social assessment they felt needed to be done in-person, as well as some tests, like the CT angiogram, that were easier to conduct in the U.S.
The donor stayed at Sentara Norfolk General for her first follow-up appointment after the procedure, but she’s since returned to New Zealand, McCune said. She’ll have future follow-up visits with the Auckland nephrologist who conducted her screenings.
Transplant programs, like many areas of healthcare, saw telehealth use tick up amid the COVID pandemic.
Most transplant centers that continued donor evaluations during the pandemic shifted to remote evaluations, according to a May survey of more than 100 transplant programs published in the journal Kidney International Reports in August. Just 13% of programs indicated using telehealth for donor evaluations before COVID-19.
Roughly 82% of transplant programs that have continued donor evaluations said they are using video-based assessments during the pandemic, while 43% were using telephone-based assessments. Only 30% of the programs reported continuing to use in-clinic assessments, according to the study.
Whether that level of telehealth use will be sustained largely depends on whether flexibilities pushed through by CMS during the pandemic are made permanent, said Dr. Krista Lentine, first author on the study and medical director for the living kidney donation program at SSM Health’s Transplant Center at St. Louis University Hospital.
“If the barriers come back, I think there will be problems again,” Lentine said. However, she stressed the need to study clinical outcomes, patient experience and access to care to determine how to continue using telehealth.
Lack of reimbursement has proved challenging for healthcare providers interested in using telehealth. Thomas Jefferson University Hospitals has historically taken on the cost of telehealth evaluations for potential organ donors.
The whole process can cost living organ donors up to $5,000 in expenses and lost wages, said Dr. Pooja Singh, medical director of kidney pancreas transplantation and the living donor program at the Philadelphia system. While the surgery itself is billed to the recipient’s insurance, she said the donor often has to take time off work, pay for travel and arrange child care.
“Whatever we can do to make it easier for the living donor should certainly be the way to go,” Singh said.
Thomas Jefferson University Hospitals began allowing some possible organ donors to complete workups and evaluations remotely in 2016, as a way to make care more convenient for people who didn’t live nearby or who had concerns about taking time off work.
Correction: This story has been updated to reflect that the kidney transplant was performed by the hospital's surgical staff.
