Virtual Platform Allows Transplant Evaluations, Wait-Listing to Continue Despite Pandemic

The implementation of a virtual evaluation platform allowed health care providers at the Medical University of South Carolina (MUSC) to maintain access to critical kidney transplants during the coronavirus disease 2019 pandemic.

A study on the use of the platform was selected for the 2020 Southern Surgical Association Program and was published online by the Journal of the American College of Surgeons ahead of print.

Patients with end-stage renal disease are required to undergo a comprehensive evaluation prior to being considered for a kidney transplant.

The evaluation often comprises of medical and surgical history, a physical and psychosocial exam, and blood testing for donor compatibility. In some cases, patients may need further blood testing or testing on various organs to determine if a patient has any conditions that could affect the immune system.

Evaluations are routinely done during 1 or more in-person visits to transplant centers, primary care offices, or offices for other kinds of physicians. However, the pandemic caused many transplant centers and health care offices to shut down for an extended period of time, limiting patient access to complete transplant evaluations.

Despite these shutdowns, the study showed that surgical teams were able to conduct more evaluations and add the same number of patients to wait lists from April to September 2020 as they did in the same period last year.

Between April and September, 1148 patients received a referral in 2020 and 1639 patients received one in 2019. During this period in 2020, 176 transplantations were performed, 930 patients received a virtual evaluation, and 282 patients were placed on a wait list compared with 177 performed transplantations, 880 evaluations, and 308 patients added to a wait list in 2019.

"Because of the platform….We can provide access to kidney transplantation even for patients who have difficulty getting to the transplant center because of where they live or who have difficulties due to their socioeconomic status," said Vinayak S. Rohan, MD, FDACS, lead study author and an assistant professor of surgery at MUSC, in a statement.

The patients included in the virtual program lived an average of 130 miles from a transplant center and 65% were African American.

The research team stratified patients who had received a recent referral from their doctor or dialysis unit for possible transplantation and were under pre-transplant review by providers and insurance carriers. Patients were placed into 1 of 3 groups: red, green, or yellow.

The red group consisted of patients whose age or medical conditions made them unlikely to be considered for transplantation and needed a full presurgical evaluation. Patients were usually over age 70 and had a history of stroke, significant cardiac or peripheral vascular disease, or poor functional status.

The green group included likely transplant candidates who could be placed on a transplant wait list. These patients were typically under 45 years old and has no history of diabetes.

Patients in the yellow group had already been placed on a wait list at another transplantation center and required minimum further analysis. These “fast track” patients were often expedited through the virtual evaluation, followed by the individuals in the red and green groups.

One telehealth visit was needed to ensure that patients access to a smart phone or tablet and had insurance coverage. The patient was then, given a scheduled check-in and a link to the doxy.me virtual platform, which was chosen by researchers because it is easy to use, complies with HIPAA privacy, and did not require additional software to complete the evaluation.

The shift to the virtual evaluation platforms was made possible thanks to the Coronavirus Aid, Relief, and Economic Security (CARES) Act that was passed in March 2020. The CARES Act included provisions that expanded Medicare coverage to allow for telehealth services during the pandemic.

Rohan said that he believed this type of program could be used across all medical specialties after the pandemic as long as there are proper regulations in place to allow for expansion of the program.

"We need to continue this practice in the future, even after the CARES Act expires, and expand care across state lines so that patients can continue having access to medical care across all specialties," said Rohan.