Donation and Transplantation Plan 2021 to 2026: annual progress update - December 2025

7. Priority 4 – Increasing living donation and reducing the wait for a kidney transplant

7.1 Ask renal units to make the default option for a first transplant for all patients needing a kidney transplant a living donor transplant.

In 2024, a Timely Transplantation short-life working group was set up to consider and address barriers to pre-emptive living donor kidney transplant and timely listing for deceased donor transplant in Scotland. Ms Karen Stevenson, Consultant Transplant Surgeon in Glasgow chairs this group.

Following a data collection exercise, the transplant units agreed a change in key performance indicators with National Services Divison. This will allow baseline monitoring of pre-emptive referral patterns and changes, including the Scottish Index of Multiple Deprivation, which will be a valuable measure of improvement.

It was agreed amongst the transplant and non-transplanting units that a Quality Improvement programme would be required to address local and national timely transplantation issues, including barriers to pre-emptive transplant listing and ensuring both donor and recipient assessments align to acheive timely transplantation.

As the REACH Transplant is now well established, the new REACH Transplant Programme Lead has been appointed with quality improvement responsibilities to faciliate this programme of work.

The Living Donor Forum meeting in December 2025 is being supported by Green Renal as part of NHS Green Healthcare Scotland which has been launched by the Centre for Sustainable Delivery, commissioned by Scottish Government. There will be a joint focus at the Forum meeting on timely transplantation and moving ahead with the quality improvement initiative.

7.2 Subject to positive evaluation of the NHS Lothian Renal Education and Choices at Home (REACH) pilot, a community, nurse-led programme of home visits to or other direct engagement (such as video calls) with patients and their family should be encouraged throughout Scotland.

REACH Transplant provides timely, nurse-led education for patients and their families/social networks in community settings and addresses known obstacles to living donation/transplantation, especially for those with lower health literacy or experiencing socio-economic or cultural barriers, thus addressing transplant inequity.

The REACH Transplant patient education initiative was expanded to cover all nine Scottish renal units in January 2023, with REACH Transplant nurse specialists in post in all units from April 2023. Currently, in November 2025, there are nine nurse specialists in post, covering seven units and ranging from 0.2 whole time equivalent (WTE) in NHS Dumfries and Galloway to 1.8 WTE in NHS Greater Glasgow and Clyde. There are two vacancies: NHS Tayside (recently appointed) and NHS Ayrshire and Arran, where the recruitment process is underway.

Since 1 January 2025, REACH Transplant nurse specialists have facilitated education sessions on living donor kidney transplantation (LDKT) in the homes of 248 suitable chronic kidney disease (CKD) patients who are approaching the need for renal replacement therapy (RRT) (or are already on dialysis), along with 487 additional members of their support network (e.g. family and/or friends). This brings the total number of potential recipients who have received home visits since January 2023 to 782, and 1452 invitees.

As well as undertaking home visits the nurse specialists have sought relevant opportunities to promote REACH Transplant locally e.g. nephrology and transplant multi-disciplinary team (MDT) meetings, Best Practice days, etc. In addition, many of the nurse specialists have provided living donation/transplantation education to those involved in looking after potential transplant recipients e.g. staff/students working in dialysis units.

REACH transplant nurses have also liaised with specialist nurses in organ donation (SNOD) to promote both living and deceased transplantation at community engagement events and have provided education sessions in primary care.

A programme of continuing professional development has been facilitated for the nurse specialists, with the support of renal and transplant clinicians in Scotland and the rest of the UK. Due to a vacancy in the role of the REACH programme lead, study days were not facilitated for some time but with the appointment of new programme lead, Ali Reed, these have restarted. The nurses have also had opportunities to attend conferences promoting living donation which has allowed networking and information sharing across the UK.

Looking forward to 2026, the REACH Transplant team will continue to develop and promote their local services. In particular it is hoped the relationship with the SNOD teams and local Organ and Tissue Donation Committees (OTDC’s) will continue to develop. REACH transplant nurses may also be utilised in the development of the Timely Transplant quality improvement programme, employing the unique position they have of developing relationships in the patient’s home and the potential for teaching and improving health literacy through promotion of peer support and prehabilitation programmes.

7.3 The Living Donation Scotland Board will prepare guidance for referring Renal Units on recommended staffing levels to support living donation.

The guidance for referring renal units on recommended staffing levels to support living donation has been completed and presented at the Scottish Donation and Transplant Group meeting in April 2024. It has subsequently been circulated to all referring and transplant unit managers.

The NHSBT living donor coordinator workforce planner was utilised to demonstrate staffing requirements for living donor coordinators/specialist nurses (with adaptation for the input into recipient programmes and deceased donor oncall impact). Calculations were made to demonstrate current staffing needs and requirements if living donor numbers are to increase. Individual units are using these figures within business plans and to highlight areas of current shortfall. It was also identified during this work that a number of clinical hours were being spent doing work which would be more efficiently completed by appropriate administrative staff, such as the reimbursement of donor expenses.