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For patients with advanced kidney disease, making it on to a transplant list can be the difference between life and death.
But getting a transplant often involves months of appointments and testing, all while patients run out of time.
A new programme, begun in the Bay of Plenty, is increasing the life expectancies of patients by shortening the testing - or work-up - process to a single day.
Te Whatu Ora Hauora a Toi Bay of Plenty nephrologist and GP Dr Scott Crawford said a timely kidney transplant could extend the life of a patient with chronic kidney disease by up to 14 years and save about $470,000 in treatment costs over six years.
“Focusing on reducing the time spent on transplant evaluation testing prior to getting on to the transplant list is key,” Crawford told the Bay of Plenty Times.
Crawford has spearheaded the one-day renal transplant work-up programme at Te Whatu Ora Bay of Plenty.
Crawford said the programme’s aim was to get patients listed for a transplant before they needed dialysis.
“On dialysis, patients may become medically ineligible to be considered for transplant during their ‘evaluation period’. They may simply run out of time as other health conditions get worse.”
One 42-year-old mother-of-four from the Western Bay of Plenty, who spoke to the Bay of Plenty Times anonymously due to the confidential nature of the transplant process, said the programme had been “a great help”.
“I have stage-five chronic kidney disease and will eventually need a kidney and pancreas transplant,” the woman said.
“You have to get a lot of tests done to make sure you’re a good candidate for a transplant, though.”
(From left): Nephrologist Dr Scott Crawford, Te Pare ō Toi health navigator Marie Tata, clinical application trainer Amanda Chapman and renal scheduler Paula Sidwell.
The woman said she would normally have had to go through tests in several different departments with appointments on different days.
“But I was lucky because I was the first person to be asked if I would like to do the single-day work-up process.”
The woman had six tests in one morning, arriving at the hospital at 8.30am. The process was complete just after lunch.
“If it had been done the old way, it would have meant whānau members helping out and someone else having to drive me.”
The woman is currently on the list to get a transplant.
“[It’s] a good feeling because I’m on to the next stage of the process,” the woman said.
Crawford said the programme worked to help patients overcome barriers by involving a social work team, using a single scheduler known to the patients, and co-ordinating with specialists.
“This is a team effort, a whole-of-system change which involves doctors, nurses, social workers and schedulers coming together,” Crawford said.
“It is a truly patient and whānau-centred approach.”
Crawford said the programme also aimed to reduce inequities of access felt by different groups of people, such as those living in a rural, regional or remote location.
Kidney specialist and University of Otago deputy dean and professor of medicine Suetonia Palmer.
University of Otago deputy dean and professor of medicine Suetonia Palmer described the Bay of Plenty programme as “incredibly important”.
“It empowers patients to prepare for a kidney transplant in a way that saves their time and energy.”
Palmer, whose research focuses on how kidney disease treatments can address profound inequity, said the programme was an example of the system working for the patients.
“They won’t need to travel multiple times for multiple appointments, will have less time off work and need to rely less on family and friends to support child care and other commitments.”
Palmer said getting on the transplant list in time was “essential” for patients.
“Transplants literally save lives. [But] sometimes, if people wait too long for a transplant, they can get too sick to receive one.”
A Te Whatu Ora Bay of Plenty spokesman said as a direct result of the programme, three patients have already been placed on the national transplant list, with a total of 17 others being enrolled, many of whom are now waiting for review by specialist transplant teams from Auckland Regional Transplant Group.
Forty-two per cent of the patients taking part in the single-day renal transplant work-up have been Māori.
The programme is a cross-departmental effort between Te Whatu Ora – Health New Zealand Hauora a Toi Bay of Plenty’s renal service, Māori health service Te Pare o Toi and the various planned care services which provide the investigations.
Maryana Garcia is a regional reporter writing for the Rotorua Daily Post and the Bay of Plenty Times. She covers local issues, health and crime.
