Collaboration between Dialysis and Transplant Social Workers Facilitates Access to Kidney Transplantation

BACKGROUND AND PURPOSE: Dialysis social workers (DSWs) are integral in the transplant process as they are often the preliminary providers of transplant education and initiate the referral process, which includes transplant education, screening, and referral. The transplant process requires regular communication and partnership with transplant centers. However, there is limited information on the direct collaboration between dialysis and transplant social workers, which may improve the transplant referral and evaluation process. Therefore, we conducted a mixed-methods study to understand the role of DSWs in kidney transplantation, as well as the transplant referral and evaluation process in Central Texas.

METHODS: DSWs completed online surveys and participated in virtual, semi-structured interviews. Two research team members collected qualitative data. The data was recorded, transcribed, and analyzed by three coders utilizing thematic analysis. Quantitative data included demographics, DSW role, caseload, transplant eligibility, and the transplant referral process.

RESULTS: 27 DSWs completed surveys and 15 DSWs were interviewed across ten counties in Central Texas. 93% identified as female and 89% as White. The median caseload was 105 patients (IQR 91-125).

Most DSWs (81%) were the identified team members responsible for assessing transplant eligibility. DSWs referred most patients (67%) for transplant evaluation within 3 months of dialysis initiation, and most DSWs (82%) described the transplant referral process as somewhat or very easy. Qualitative themes further elucidated the transplant screening and referral process, and collaboration between DSWs and transplant social workers. Thematic analysis identified that some DSWs reported submitting "blanket referrals,” for which they referred almost all their patients and deferred eligibility screening to transplant centers; while other DSWs described a more in-depth screening process, including an assessment of social barriers and patient motivation.

While DSWs felt strongly about the importance of kidney transplantation, DSWs reported limited interaction and communication with transplant social workers. This led to some reports of tension between dialysis and transplant centers due to a lack of communication and clear partnership throughout the referral and evaluation process. DSWs recommended increased communication with transplant social workers to facilitate greater collaboration and care coordination of patients referred for transplant.

Additionally, DSWs recommended more professional transplant education, standardized referral submission processes, systematic tracking of transplant candidates, and regular progress updates of patients referred or waitlisted to improve access to kidney transplantation. Furthermore, DSWs also suggested monthly “lobby days” where transplant staff such as a social worker, liaison or outreach coordinator can meet directly with dialysis patients to provide transplant education and answer any questions about the transplantation referral and evaluation process.

CONCLUSIONS AND IMPLICATIONS: DSWs are essential to identifying and referring patients for kidney transplant evaluation. Improving direct collaboration between DSWs and transplant social workers through standardizing referral processes with regular interaction about evaluation and waitlist decisions facilitates access to kidney transplantation. These findings can inform future clinical practice between DSWs and transplant social workers to improve care coordination between entities that are vital to facilitating access to kidney transplantation.