With a team approach to the ILDA role , all who are involved in the evaluation and management of potential and actual live donors have a primary role to care for the donor. They are “independent” of recipient care (or intended recipient care) and decisions are not influenced by recipient needs. Table 9.2 summarizes the benefits of a team approach to advocacy. A significant benefit of an ILDT is that each member comes from different disciplines and brings his/her own area of expertise and personal experiences to the team and may interpret a donor’s questions and responses differently. Their interactions with the donor vary based on these variables, and a potential donor may be more candid or bond more with one advocate versus another. The roles and responsibilities of each team member should be delineated ahead of time to maintain appropriate boundaries, avoid conflict, and send a consistent message to the potential donor. The ILDT has expertise in different aspects of donation and transplant; however, to be successful, it is crucial that all understand the end-stage organ disease and the transplant process so that they can accurately depict the process. At a minimum, each member should possess the knowledge expected of the donor at the completion of the evaluation . Each advocate is responsible for education and reinforcing key concepts. Repetition and time for questions can improve the education process.

At the completion of the potential donor’s comprehensive evaluation, the ILDT should formally meet to review each donor evaluation results and discuss the impression of each individual meeting. Discussion within the team in order to reconcile any differences in views about a donor’s suitability to donate can help to ensure sound reasoning regarding candidacy recommendations. Additionally, as donors mature through the process, their feelings, thoughts, and concerns about donation may change, and a team—by virtue of its multidisciplinary composition—may identify additional areas to focus interventions. As with all teams, a strategy to handle differences of opinions and managing conflict within the group must be identified ahead of time.

The professions that make up a team of advocates may vary at each center; however, critical members include the physician assigned to medically evaluate and assess risk, the transplant nurse coordinator assigned to educate and oversee the process, and the social worker assigned to assess psychosocial risk, competency, and coercion. Other clinicians that add benefit to the team include the donor surgeon, psychiatrist, nutritionist, financial counselor, and ethicist [5]. One may argue that the additional transplant staff, such as nutritionist or financial coordinator, are not involved with donor advocacy ; however, their role is crucial with select donors. For instance, a young obese kidney donor may need a nutritionist to educate him/her about weight loss and the need for long-term healthy eating. If a potential donor cannot comply or is not willing to comply with such recommendations, the nutritionist may advocate for the donor choosing not to donate.

It is the entire ILDT’s responsibility to be involved in the donation process throughout the donation continuum [6]. When and for how long will vary according to the team members’ skill sets and an individual donor’s needs. The process and components of the medical and psychosocial evaluation are prescribed by the Centers for Medicare & Medicaid Services (CMS) and OPTN regulations , policies, and bylaws [1, 2]. It is, however, up to individual transplant programs to determine how they will comply with such rules and develop individual policies and protocols for live donor evaluation , education, and follow-up (Table 9.3). It is important that the input of all ILDT members is considered when developing such policies. Additionally, all members need to have a full understanding of and comply with the regulations and the program’s polices for donor care.