Trainee Spotlight: Katya Loban
We are thrilled to congratulate Katya Loban on her outstanding achievements! Katya will be presenting three abstracts at upcoming conferences: the Canadian Association for Health Services and Policy Research (CAHSPR) 2023 Conference, to be held in Montreal from May 29-31, 2023, and the American Transplant Congress, to be held in San Diego from June 3-7, 2023.
At the CAHSPR conference, Katya will be giving an oral presentation on living kidney donation entitled: “Thank you for your kidney, good-bye.”: The Canadian living kidney donor perspective. At the American Transplant Congress, she will participate in an oral presentation entitled “Are We Providing Optimal Care, Information, and Support to Living Kidney Donors? A Qualitative Study.” In addition, Katya will present a poster on “What I Desire from My Family Physician: The Living Kidney Donor Perspective.“
These presentations at such prestigious conferences are a testament to Katya’s hard work, dedication, and expertise in the field of healthcare. We applaud her achievements and look forward to hearing the valuable insights she will undoubtedly contribute.
Congratulations, Katya!
About Katya Loban
Katya Loban is a health services researcher. She is a postdoctoral fellow at the Research Institute of the McGill University Health Centre and the Department of Medicine of McGill University, working under the supervision of Dr. Shaifali Sandal. Katya is also a trainee with the Canadian Donation and Transplantation Research Program (CDTRP). Katya holds a PhD in Family Medicine and Primary Care, an LLM in International Dispute Resolution and an MA in Organization Development. She has 14 years of professional experience in the areas of international project management and research administration. Katya’s areas of interest include multi-stakeholder partnerships, inter-professional collaboration, the organizational aspects of health care and medical law and ethics. The aim of her current postdoctoral project is to explore the integration of primary care into the living donation trajectory, to optimize the care of living kidney donors.
Abstract for the Canadian Association for Health Services and Policy Research (CAHSPR) 2023 Conference
“Thank you for your kidney, good-bye.”: The Canadian living kidney donor perspective
K. Loban, J-T. Robert, P. Nugus, C. Rodriguez, S. Sandal
Background and objectives: Living donor kidney transplantation saves the Canadian healthcare system millions of dollars in averted dialysis costs, is the best treatment for kidney failure, and helps to narrow the persistent gap between the demand and supply of organs. Evidence suggests that this process is fraught with challenges for living kidney donors (LKDs). We aimed to obtain the perspectives of LKDs on their healthcare throughout the donation trajectory, with a focus on the role of primary care.
Approach: This was a qualitative descriptive study, entailing 49 semi-structured interviews with LKDs. Adult male and female participants who spoke English or French and donated their kidney to someone they knew or anyone in need prior to 2020 were recruited via social media and email rosters from seven transplant jurisdictions in Canada. Interviews were conducted in person or via zoom. Interview questions related to perceived gaps in the provision of information on donation, experiences pre- and post-donation and the coordination of care among different healthcare providers. Data were analyzed using inductive content analysis.
Results: LKD care lies at the intersection of primary and transplant care. Our analysis revealed: 1) variability in health information provision, 2) poor coordination between levels of care, and 3) gaps in post-donation care accessibility and comprehensiveness. Post-donation, most donors were under the care of their family physicians, some had limited annual follow-ups with transplant teams, and a minority of donors lacked access to care altogether. Many donors felt abandoned by the transplant teams. Those LKDs who felt “healthy” perceived follow-up by family physicians as acceptable, although many noted significant gaps in the knowledge of family physicians regarding LKD care. A key challenge identified was a lack of ongoing support for mental health
Conclusion: This study suggests that in Canada, a country with universal health care, LKDs have unmet needs. Its results underscore the need for stronger integrative models of primary and tertiary care, with the living donor at their core. In addition, targeted medical education initiatives for primary care practitioners are needed.
Abstracts for the American Transplant Congress
Are we providing optimal care, information, and support to living kidney donors? A qualitative study
K. Loban, J-T. Robert, H. Badenoch, A. Bugeja, P. Nugus, C. Rodriguez, S. Sandal
Purpose: Living kidney donors (LKDs) experience several challenges when pursuing donation and their follow-up care is suboptimal. Data from the US have demonstrated that many centers are not in compliance with the Organ Procurement and Transplantation Network/United Network for Organ Sharing mandated follow-up of LKDs and that lack of health insurance may play a role. Thus, we wanted to explore the experiences and needs of LKDs in Canada as they transition through the five phases of their donation trajectory.
Methods: This was a pan-Canadian qualitative descriptive study, entailing 49 semi-structured interviews with LKDs who were recruited via social media or email rosters. Data were analyzed using inductive thematic analysis.
Results: Participants reported: 1) unmet health information needs prior to donation, 2) poor coordination and lack of continuity between primary care and transplant teams, 3) inconsistency in post-donation care protocols, 4) challenges with access to care post-donation, and 5) suboptimal long-term follow-up. Post-donation most donors were under the care of their family physicians, some had annual follow-ups with transplant teams exclusively for monitoring remaining kidney function, and a minority of donors lacked access to care altogether. Many donors often felt abandoned by the transplant teams post-donation, particularly in light of very intense screening and evaluation leading to surgery. Those LKDs who felt “healthy” perceived follow-up by family physicians as acceptable, although many noted significant gaps in the knowledge of family physicians regarding donor care. A key challenge identified by nearly all donors was a lack of ongoing support for mental health.
Conclusions: We report that even in a country with universal health care, LKDs have unmet needs. Our data can inform targeted multi-disciplinary interventions to improve care coordination, facilitate early detection of problem symptoms and enhance the experiences of LKDs which would, ultimately, lead to better short- and long-term patient outcomes.
“What I desire from my family physician”: the living kidney donor perspective
K. Loban, J-T. Robert, H. Badenoch, P. Nugus, C. Rodriguez, S. Sandal
Purpose: In the US, transplant centers are mandated by the Organ Procurement and Transplantation Network (OPTN) to follow living kidney donors (LKDs) for two years after donation, yet a majority of LKDs are lost to follow-up. LKDs are healthy individuals whose main health care contact prior to and after donation are primary care practitioners, such as family physicians (FPs). Better engagement of FPs can inform improved compliance with the OPTN policy as well as optimal long-term care of LKDs. We aimed to obtain the perspectives of LKDs on the role of FPs pre- and post-donation.
Methods: This was a pan-Canadian qualitative descriptive study that aimed to obtain the perspectives of LKDs. We chose Canada as the setting for this study as lack of insurance is not a major barrier to access care. We conducted 49 semi-structured interviews with LKDs who were recruited via social media or email rosters. Data were analyzed using thematic analysis.
Results: Having a FP was a prerequisite for being a LKD for most transplant programs. Post-donation, most LKDs were under the care of their FPs. In practice, the role of FPs was confined to occasional pre-donation physical screening and limited long-term follow-up. Participants reported poor coordination between primary and transplant care and significant gaps in the knowledge of FPs regarding living donation and long-term donor care. A few stated that their FPs implicitly or explicitly discouraged donation. Desired roles for FPs included health information brokerage, mental health support and long-term kidney function monitoring. Some illustrative quotes are highlighted in Table 1.
Conclusions: We have identified several opportunities for improving long-term donor follow-up and care much beyond the two-year mandate from the OPTN. Given that LKDs are generally under the care of a FP pre- and post-donation, targeted medical education initiatives and stronger integrative models of primary and tertiary care are needed.