Table 2:

Participant quotes that illustrate each theme that was identified as a facilitator to living donor kidney transplantation in British Columbia

ThemeIllustrative quote
A centralized infrastructureIn BC, there is one provincial health authority, which funds BC Renal [Agency] and BC Transplant through MOH [Ministry of Health] dollars and has the mandate to enable provincial services. The centralization of funding and clarity of mandate; helps break down the silos to some extent. (Representative from BC Renal Agency 1)
I think that’s a huge strength in BC, is the communication with the Kidney Care Clinics and the provincial renal agency as well as BC Transplant. We are lucky that it’s one big program here. And that the communication is the same and that we work and have the same messaging across centres and sites. (Transplant centre nurse 1)
We have the provincial renal agency, which does a lot and they promote a lot. And we have our database and we have — they are always working on new teaching and patient materials and DVDs and stuff. (Kidney Care Clinic nurse)
A mandate for timely interventionSo generally speaking, the Kidney Care Clinics in our province try to refer people that are transplant suitable, are eligible, when their GFR [glomerular filtration rate] is around 20–25. So the thinking is that gives us enough time to be assessing them and helping them find a donor in time. (Transplant centre social worker 1)
We’re seeing that recipients are being referred a little bit earlier for their transplant assessments, but conversations are also starting earlier about living donation. So, we will see and hear from living donors much earlier in the process so that they have time to work through it prior, ideally, before their recipient needing to start dialysis. So, we’re really trying to support pre-emptive living donor transplant where we can. (Transplant centre nurse 1)
It was just going so perfectly down the road as things went along. And it was sort of nice maybe, not to be flooded with all the information, too. (Living donor recipient)
An equitable funding modelSo, in BC, we use let’s call it an activity-based funding model, meaning you get a certain bundle of funding per patient-year of services. And what’s built into that is all the activities that are assumed to take place through the year. And so, yeah, [in 2015] that’s when they added a lift to specifically say that one of the items, once people got down to a certain GFR [glomerular filtration rate], is that they would be assessed for transplant. It’s relevant because even though it’s just a small amount for each patient, in aggregate, it can become a large amount. And that’s what, it actually let some places — like, for example, where I work in xxxx — it let us set up a dedicated, we have a couple of dedicated nurses, who specifically do this transplant work. (Representative from BC Renal Agency 2)
It’s a lot easier to lobby a transplant organization to give you funding for transplant than it is to lobby a hospital, who has to support everything. (Representative from BC Transplant 1)
A commitment to collaborationI think everybody in the renal world is pretty well-connected to ask questions or provide good care and figure out how we can make things work better. We are always kind of asking that question. (Kidney Care Clinic social worker)
There’s a large working group that includes nurses, patients, doctors, transplanters and social workers. And they’ve come up with a work plan [for Transplant First] and they’ve come up with tools. (Representative from BC Renal Agency 1)
That’s, I think, the key piece of it. Working together, working collaboratively, bringing in the regions, working with the Kidney Care Clinics. (Pretransplant clinic nurse 1)
Cultivating distributed expertiseSo there is an initiative, a pretransplant initiative, training all our CKD [chronic kidney disease] nurses in terms of recognizing patients that would benefit from pre-emptive transplant and beginning the whole workup. So, the nephrologists are aware of this as well. But this comes from the ground up. So when I walk in to see a patient for clinic, my nurse might say, “hey, so-and-so has a donor. I was talking to her about transplant. Can we refer her?” So it’s not only got the nephrologists thinking about it, but we’ve also got our nurses prompting us. (Kidney Care Clinic nephrologist)
Everyone’s open to talking about it – all of our team members are open to talking about transplant and feel, you know, some comfort level in doing that (Kidney Care Clinic social worker)