AUTHOR=Nightingale Katie , Stephenson Josh , Sivaprakasam Rajesh , Brown Tim , Inston Nicholas , Hamsho Ahmed , Ravanan Rommel , Nicholson Michael , Asderakis Argiris , Browne Sarah , Hunter James , Marson Lorna P. , Connor Katie L. , Kelleher Mortimer , Sutherland Andrew , Norton William , Maple Hannah , Calder Francis , Dor Frank J. M. F. , Barlow Adam , Wijetunga Imeshi , Youngs Rachel , Falconer Stuart , Boardman Victoria , Smith Matthew Welberry , Bagul Atul , Sharma Hemant , Mehra Sanjay , Moinuddin Zia , Campbell Tunde , van Dellen David , Rogers Alistair , Burnapp Lisa , Haq Kamran , Yates James , Sinha Sanjay , Malik Shahzar , Saif Imran , Gibbs Paul , Khan Kashuf , Harvitkar Rafique , Shrestha Badri , Ghazanfar Abbas , Siddiky Abul , Motallebzadeh Reza , Moneke Michael , Bhatia Kailash , Augustine Titus 

TITLE=The Variation in Practice of the Living Donor Kidney Transplant Pathway in the UK: Results of a National Survey

JOURNAL=Transplant International

VOLUME=Volume 38 - 2025

YEAR=2025

URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2025.15341

DOI=10.3389/ti.2025.15341

ISSN=1432-2277

ABSTRACT=Living donor kidney transplantation (LDKT) accounts for 35% of kidney transplants in the UK. The Organ Donation and Transplantation 2030 initiative underscores the necessity to enhance LDKT rates to meet growing demand. There is limited data on national variations in live donor workup pathways from initial referral to long-term follow-up. We conducted an online survey across all 23 UK transplant centres performing LDKT, covering the entire living donor pathway. We aimed to explore and highlight practice variation and identify opportunities for improvement. Responses were received from 21 centres (91.3%). Marked variation was identified in donor acceptance criteria, including age limits, body mass index thresholds, and donor evaluation timelines (6–36 weeks). Differences were also noted in multidisciplinary team processes, kidney laterality decisions, and perioperative enhanced recovery protocols. All centres used laparoscopic techniques, with hand-assisted transperitoneal nephrectomy being most common (57.1%). Donor nephrectomy and implantation were conducted sequentially in 15 (71.4%) of centres, and in parallel in six (28.6%). Variation was also seen in follow-up duration with 47.6% of centres offering lifelong follow-up. Despite excellent national outcomes, this survey highlights significant variation. Standardising key processes could streamline donor pathways, improve experiences, and support increased LDKT activity in the UK.