RECOMMENDATIONS

1. Improve Outcomes of First Transplants
   
   Financial - Cover immunosuppressive drugs for life
   
   Education - Educate CKD Stage 4 patients about
   • staying as healthy as they can
   • the opportunities for and benefits of early transplantation
   • the possibility of living donations and
   • the identification of potential living donors
   Medical Practice -
   • Evaluate Stage 4 CKD patients for a transplant prior to the initiation of dialysis
2. Increase Deceased Donation
   
   Financial - Ensure that OPOs have the discretion and funding to assist donor families with expenses directly related to the donation, which may include some funeral expenses
   
   Education - Facilitate awareness of all appropriate hospital personnel about the optimal care for potential donor families
   
   Medical Practice -
   • Minimize discard and maximize utilization of donated organs
   • Identify, recover and utilize organs from Extended Criteria Donors and from Donation after Cardiac Death donors nationwide
3. Increase Living Donation
   
   Financial -
   • Guarantee that all living donors, without qualification, are reimbursed for all expenses involved in the donation, including lost wages. This includes non-directed donors and potential donors who are evaluated but don't ultimately donate.
   • Guarantee living donors access to health care coverage for any medical expense or disability related to the donation
   • Guarantee living donors life insurance coverage for death related to the donation
   • Guarantee that living donors get their jobs, or equivalent jobs, back
   • Guarantee that living donors will not be discriminated against in obtaining health and life insurance
   • Establish a specific billing code for post-donation care of living donors
   Education -
   • Create an NKF Living Donor Council to support the needs of living donors and potential donors
   • Create a "Living Donation Breakthrough Collaborative" to stimulate best practices for living donation
   • Inform the general public about new developments in living donation and transplantation
   
   Medical Practice -
   • Increase staff and physical resources at transplant centers to minimize the time waiting for a living donation
   • Evaluate more than one potential living donor for a single recipient when feasible
   • Collect, maintain and analyze data on living donors annually, consisting of, at least, blood pressure, eGFR, proteinuria and Hb A1C
4. Make the donation and transplant system and processes more efficient and equitable Medical Practice -
   • Eliminate regional variations in the rates of consent, living donations, early transplantation, access to transplantation and follow-up care
   • Eliminate racial and other disparities in donating, listing, remaining active on the waiting list and receiving a transplant
   • Maintain uniform organ donation laws across the United States