Oct 12, 2023
From Silos to Integrated Systems: Improving Transplantation Access and Outcomes

For many, kidney transplant is the optimal life-saving treatment for end stage kidney disease. Yet the path from diagnosis to transplantation can be extraordinarily long and complex. I saw this first-hand during my career as a transplant center administrator, and have made tackling these problems my focus in my role as senior director of DaVita’s national transplant team.

The historical causes of inefficiencies in transplant access are many and varied, and the solutions required are equally complex. Yet a simple principle — cooperation — lies at the heart of many of them. In the most basic assessment, progress depends on breaking down functional silos to create connected systems of care that consistently center on the patient.

"Progress depends on breaking down functional silos to create connected systems of care that consistently center on the patient."

– Will Maixner, senior director of the national transplant team at DaVita

At DaVita, we envision a future where dialysis providers, transplant centers, community health organizations, payers, government entities — indeed, representatives from the entire kidney health sector — come together as true collaborators in an integrated, patient-centric ecosystem. We can’t realize this vision alone, and we’re inspired by the many caregivers and organizations who share our commitment. But as a large-scale provider reaching hundreds of thousands of patients across the United States and around the world, DaVita is in a unique position to spearhead meaningful change. This is the challenge that drew me to the company, and the opportunity that keeps me passionate about my work every day.

Our work in transplantation seeks to help improve rates of living donation, support equitable transplantation access and outcomes, and strengthen collaborative infrastructure.

In support of living donations, DaVita’s 2022 acquisition of technology innovator MedSleuth marked a milestone in our transplantation commitment. The waitlist for a kidney from a deceased donor is years long, while living donation can enable life-saving transplantation within weeks or even days. Despite this significant benefit, today less than 30% of transplants come from living donors, and finding a willing medical match creates further challenges. MedSleuth’s tools, BREEZE TRANSPLANT™ and MATCHGRID™, are designed to help improve transplant center living donation programs by building efficiencies that help evaluate a vast pool of potential donor-recipient combinations in minutes.

Health equity, empowering every patient to achieve their best health outcome, is a focus for DaVita. Yet today, Black patients experience disproportionately high rates of kidney disease and lower-than-average rates of waitlisting and transplantation. Arising from multiple complex and intersecting root causes, these disparities require the focus of the entire kidney care sector, and the health care industry at large. At DaVita, we’re determined to leverage our scale and leadership position to hasten the pace of improvement.

By diving deep into social determinants of health, improving our internal and external education, and collaborating closely with organizations within the communities we serve, we’re fighting the problem from multiple angles. Our Health Equity Learning Lab, launching this fall in Maryland and Philadelphia, is just one example of how we’re working to meet patients where they are. This pilot is designed to continue furthering our understanding of disparities in transplant, help support individuals in their own journeys and enable us to consider both individualized and scalable solutions for a more equitable system.  By prioritizing locally attuned, culturally relevant communications, we aim to ensure that our transplant education and support conforms to patients’ lived experience — not the other way around.

Finally, together with our colleagues throughout the kidney care sector, we’re strengthening the foundations of our collaborative infrastructure by standardizing care coordination with transplant centers. Technology updates, such as standardized referrals through MedSleuth’s Breeze platform, provide a more comprehensive interface at the moment of referral, reducing downstream administrative delays.

It would be disingenuous to suggest that the path ahead will be easy. The transplant waitlist far exceeds the number of transplants, and disparities in transplant access remain at unsatisfactory levels. But it is imperative that all of us, as a healthcare industry, reject this status quo. At a moment when stakeholders from every sector are keenly attuned to historic ineq­­uities and inefficiencies in healthcare, the opportunity to change course is in reach. At DaVita, w­­e’re proud to help lead that charge for the simplest of all possible reasons: Lives depend on it.

Will Maixner is the senior director of DaVita's national transplant team.