Kidney Donation and Transplant Outcomes in Trinidad and Tobago: A 15-Year Experience of the National Organ Transplant Unit.

Objectives: Trinidad and Tobago is the only English- speaking Caribbean country with an established kidney transplant program from living and deceased donors. The program is managed by the National OrganTransplant Unit.This study analyzed the 15-year experience of the public program in terms of transplant outcomes and procurement quality at the main deceased donor procurement hospital using some DOPKI and ODEQUS quality indicators.

Materials And Methods: We collected data from 2006 through 2020 from the National OrganTransplantUnit database, surveyedhospital staffonorgandonationand transplant after face-to-face education activities on these subjects, and provided an online survey to religious leaders.DOPKI and ODEQUS quality indicators from 1 procurement center were also recorded.

Results: During the data collection period, 195 transplants were achieved, with 23.6% from deceased donors. Deceased donation and deceased donor kidney transplant rates ranged from 0.71 to 3.6 and from 0.71 to 7.1 per million population, respectively. Since 2011, deceased donor registry and actual deceased donors increased 6-fold and 14-fold, respectively, while living donor transplants doubled and deceased donor transplants increased 15-fold. Quality parameters revealed major gaps in deceased donor critical pathway, with limited transplant budget, absence of hospital budget for deceased donor organ retrieval processes, important deficiencies in deceased donor registry and waiting lists, refusal of expanded criteria donors, and missed donation opportunities from poor HLA reagent supply chain management. Religious leaders and health care workers showed supportive positive attitudes toward organ donation and transplant.

Conclusions: The public organ donation and transplant program of Trinidad and Tobago has performed reasonably well over a 15-year period. Enhancing quality performance and donation effectiveness requires rebalancing and improving resource allocation from renal dialysis to kidney transplant, funding deceased organ procurement, and facilitating education of religious leaders and health care professionals for end-of-life care and change of community values in organ transplant decisions.