Apr 24, 2024
For Improving Transplant Access, Collaboration Holds the Key

DaVita’s work with Kansas City-area transplant centers has helped streamline communication, create solutions to support patients.

Kidney transplant is the ideal treatment for those with end stage kidney disease (ESKD) who are eligible for, and interested in, this potentially life-saving procedure. Yet traditionally, the path to transplantation has been long, complex and frustrating for patients and healthcare providers alike. Recently, a committed community of providers in the Kansas City region dedicated themselves to proving that it doesn’t have to be that way.

In early 2021, DaVita dialysis providers initiated an audit of their operations, seeking ways to better support transplant access. This process revealed critical gaps in communication between dialysis centers and their nearby transplant providers.

“Everybody [in the kidney health community] wants to achieve the same goal, what’s best for the patient,” explains Cheryl Matlack, DaVita’s division lead social worker in the region. “But dialysis centers and transplant facilities didn’t necessarily have the right processes in place to support those shared goals as effectively as they could.”

Matlack and other leaders involved knew that no matter how deep their commitment, DaVita couldn’t bridge this chasm alone. Transforming communication would take changes on both sides. “It wasn’t necessarily easy at first,” Matlack recalls. “Both sides had to be ready to hear what they weren’t doing perfectly, and really listen to what the other side needed.”

So, they reached out to transplant centers to form collaborative workstreams, including The University of Kansas Health System (The Health System), HCA Midwest Health Research Medical Center (Research Medical Center) and Saint Luke’s Hospital Abdominal Transplant and Multispecialty Clinic (St. Luke’s).

Jaime Bartley, director of nursing at The Health System transplant center, and Wendy Cundiff, organ transplant coordinator for TUKHS, noted that while their team had already had a relationship with the DaVita care teams, the collaboration Matlack and the rest of the DaVita team put forth made sense:

“There was a willingness to share more information, understanding that we could make a difference in streamlining it,” Cundiff says. “These conversations made it clear that transplant is important to DaVita. They are invested in getting people on the waitlist.”

“When you have that relationship that’s based on collaboration, you can have that level of open conversation,” Bartley says. “Questions like, ‘What do we need? Can we do this better? How?’”

New ways of working began at the senior level, with leaders from both sides establishing a regular cadence of meetings to share ideas and information. Transplant centers in the area invited DaVita representatives to events and workshops to help improve cross-functional understanding. Out of these collaborations, a new protocol — the “pipeline call” — was born.

Pipeline calls are routine points of contact where front-line clinical social workers and transplant coordinators can talk through patients’ needs and status upstream, far before they reach the transplant waitlist. This is just one example of process standardizations that remove obstacles and solve problems on the transplant journey.

“Before pipeline calls, our transplant center was taxed with mailing out spreadsheets with evaluation statuses,” says Marilee Clites, RN, BSN, the transplant director for Research Medical Center. “Now, both parties have the opportunity to directly communicate.”

“As a result of the calls and countless emails, I feel like the DaVita social workers are part of our transplant team family,” says Scott McClure, RN BSN, the transplant outreach coordinator for Research Medical Center. “I can always rely on them to help our patients get the best, most compassionate care.”

The dedicated time provided the structure for both sides to discuss details about why a patient might be “stuck” in the transplant journey. “The new structure gave social workers the opportunity to ask specific questions about their patients’ evaluation status, instead of relying solely on patient update letters, which were difficult to keep up-to-date in real time due to the nature of mailed correspondence,” Michelle Goldston, LMSW, transplant education representative for St. Luke’s says.

“We have recognized that this two-way communication is so valuable,” Cundiff says. “They recognize our needs; we’re recognizing their needs — for the same goal.”

In addition to process and communications improvements, greater collaboration fueled expertise on all sides, especially in the complex process for transplantation.

“It’s really led to a huge uptick in knowledge,” explains Matlack. “When each side understands the other’s job more clearly, it creates opportunities for mutual support and solving problems together.”

One specific example illustrates this vividly: Many transplant centers require colonoscopy as a prerequisite before a patient can be evaluated, but it’s not something patients are commonly aware of. This requirement often popped up as an unexpected stumbling block, slowing or even stalling the transplant journey. With greater shared understanding of common requirements, the colonoscopy step can be identified and communicated farther upstream, empowering the patient to get ahead of the process and stay on track.

Sreelatha Katari, MD, medical director of the kidney transplant program at St. Luke’s, shares that it’s also helped the teams communicate and act on care needs for transplant eligibility:

“The St. Luke’s transplant team can recommend that the dialysis social worker identifies patients who need physical therapy and help get that ordered,” Dr. Katari offers as an example. As a potential result: “Their candidacy for kidney transplant improves and shortens the workup time for transplant.”

While some of the improvements activated in the Kansas City region may seem simple, their impact has been profound. Recently, the team at The Health System published a research poster illustrating some of the progress their team has made with the DaVita team. In the poster, the The Health System team reported that the collaboration has helped double the transplant referral and evaluation rates, while the rate of placements on the transplant waitlist has increased 400% from DaVita facilities when compared to overall referrals, evaluations and listings. [1]

DaVita, seeing the advancement these new processes and methods have helped create, is now looking to create similar opportunities with transplant centers nationwide. But more than just a shift in protocols, this case illustrates the power of a shift in mindset. Says Matlack,

“It used to be understood that the job of dialysis was to keep patients healthy so they would be ready for a successful ‘hand-off’ to transplant, but now we see the dialysis team as a critical partner in supporting the whole journey. Even though some caregivers work in dialysis and some in transplant, we’re really all on one team — the patient’s team.”


[1] 2023 The University of Kansas Health System; Wendy Cundiff, BSN, RN; Jaime Bartley, MSN,RN, NE-BC, CCTC; “A Winning Combination: Teaming Up to Enhance the Transplant Process;” Presented at The Organization for Donation and Transplant Professionals NATCO 48th Annual Meeting, August 2023