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How transplant testing improves clinical productivity


read time: 4 minutes


Pathology & Laboratory Medicine

The organ transplant field has continued to generate improved outcomes over the past decade. Patients are being diagnosed earlier thanks to more precise tests. An increased emphasis on patient experience has boosted quality of care. And physicians are incentivized for better patient management, leading to faster decisions about whether a patient should continue to take medicines or be placed on a transplant list. Even successful multiple organ transplantation is on the rise.

Yet significant room for improvement exists in the organ transplant experience. Upwards of 30% of transplanted organs are still rejected.1 This could be due to a combination of quality and availability of donor organs, gaps in monitoring, or spotty reporting. The financial implications are significant as well. According to a 2020 paper, the annual cost to the US healthcare system of failed kidney grafts alone is in excess of $1.3 billion, or more than $78,000 of additional medical costs per patient.2

Understanding real-world behaviors

To help close some of these gaps, we must consider the lived patient experience and address it in the solutions we collectively provide as a healthcare community.

Understandably, most organ recipients want to get back to enjoying their lives once they feel physically better. But if a patient skips a month of testing for whatever reason, a disease linked to their immunosuppressed state may have time to progress to the point where aggressive treatment is required.

Other considerations that contribute to reduced compliance include the fact that patients may not live close to the transplant center where their surgery is performed. Some also move around by choice: since transplant patients skew older, many are snowbirds and spend part of their year in one city or town and part in another. In these cases, a gap of 1 or 2 lab visits can occur as one of their homes may not be physically located near their physician network. 

"Having a convenient and accessible lab network matters to patient compliance because it helps to ensure consistent, standardized results regardless of the patient’s physical location."
- Ann E. Salm, MS, PhD

And there is the fact that for some, the out-of-pocket cost of testing at some labs may simply be too high. All these factors contribute to compliance gaps in the early stages of post-transplant testing that run as high as 20 to 50%.3

Improving transplant outcomes with a patient-centric testing approach

For physician peace of mind and optimal patient health and compliance, health systems and hospitals should consider a patient-centric service offering. Several lab networks, including Quest Diagnostics, have introduced this test and service innovation-based model recently, but not all are created equal.

Ideally, this approach should do 3 things: 

Provide the complete clinical picture
LIS/EMR connectivity that puts complete laboratory results in front of the transplant physician and extended care team is invaluable in preventing transcription errors and keeping the organ recipient aware of when the next tests are scheduled. Clinical integration of test results helps to ensure that patients stay compliant. Ideally, physicians should receive test reminders, electronically order a test, reach out to the patient to take the test, and see the results appear in an EMR report with little to no effort.

Make care and compliance frictionless
Having a convenient and widely accessible lab network contributes to improved patient compliance because it helps to ensure ease of testing and consistent, standardized results regardless of the patient’s physical location. It also frees the physician from having to re-baseline their patient’s results based on results from different lab networks.

Another element of frictionless care is good lab stewardship. When clinicians have a question about medical guidelines or system protocols, their lab’s services provider should be available to consult. Likewise, a patient should be able to walk into a patient service center anywhere in their lab’s network and get a quick, cost-effective blood draw when they are reminded that a test is due. That test should be run with an appropriate turnaround time to the physician.  

Offer fast, end-to-end results
Transplant testing should extend from pre-transplant through procedure to post-transplant care. If a matching donor for a patient appears on a wait list, time is of the essence, and test results should be returned within 24 hours of receipt of the sample in the lab. After returning home, a patient’s remote location should not present a gap to post-transplant infectious disease testing, either. Here results should be available even faster, ideally within 12 hours of receipt of the sample in the lab. Proactive tracking and monitoring of specimens (eg, via FedEx), as well as flexible billing, is also key.

A seamless, end-to-end transplant testing solution—provided by a single lab services provider—can help health systems and transplant centers ensure their clinicians have access to the results they need as soon as possible. Collaborating with a lab services provider that has a nationwide footprint is one way to do this, offering testing support for any transplant patient in the country. 

Closing the gaps to better care

Wherever compliance or access issues persist in the treatment of transplant patients, it’s imperative to address them to increase peace of mind and patient outcomes post-transplant. And as far as we have come, there is a long way to go. Closing these gaps as an industry will require collaboration. It’s all about ensuring patients and their physicians have the tools—and the services—at their disposal to optimize success. 

Page Published: May 25, 2023

1 National University of Singapore, Yong Loo Lin School of Medicine. Rejection of transplanted organs: Long-awaited structure offers new insights. ScienceDaily. 14 March 2019.

2 Sussell J, Silverstein AR, Goutam P et al. The economic burden of kidney graft failure in the United States. American Journal of Transplantation. 2020. May;20(5):1323-1333. doi: 10.1111/ajt.15750

3 Laederach-Hofmann K, Bunzel B. Noncompliance in organ transplant recipients: a literature review. Gen Hosp Psychiatry. 2000;22(6):412-424. doi:10.1016/S0163-8343(00)00098-0 

About the author

Ann E. Salm, MS, PhD

Medical Science Liaison Director for Infectious Diseases/Immunology

Quest Diagnostics

Ann E. Salm, MS, PhD, has served as a director medical science liaison for the Infectious Disease & Immunology team in Medical Affairs at Quest for more than 6 years. In that capacity, she is a field clinical consultant for infectious disease and immunodiagnostics, focusing on TB and tick-borne disease diagnostics and autoimmune testing. She also provides scientific data internally to sales team members and externally to opinion and thought leaders in her clinical disciplines. Finally, Dr Salm assists in the development and implementation of training programs, and offers support to Quest clinical trial networks, as well as to research and development.

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