Breaking barriers: A decade-long institutional journey to sustain mandated living kidney-donor follow-up in Qatar.

INTRODUCTION: Living kidney donation is essential for expanding transplant opportunities, given the worldwide scarcity of deceased donor organs. Kidney donors experience a slight but detectable long-term increase in risks such as hypertension, diabetes, and end-stage kidney disease, making sustained follow-up essential. However, adherence to post-donation surveillance remains inconsistent worldwide. METHODS: This descriptive evaluation included living kidney donors enrolled in Qatar's national follow-up program at Hamad Medical Corporation, implemented in January 2017. The program mandates nephrology follow-up at 1 and 6 months post-donation and annually thereafter, with standardized clinical and laboratory monitoring. Adherence rates from 2017 to 2024 were assessed against institutional benchmarks (>90%). RESULTS: Of 349 registered donors nationwide, 233 donated after program implementation. Despite a fourfold increase in eligible donors between 2017 and 2024, 1- and 6-month follow-up rates remained near 100%, and annual adherence consistently exceeded 90% from 2020 onward. Compliance with the nephrologist-led review of clinical and laboratory data approached 100% among attendees. Sustained performance was temporally associated with system-level interventions, including coordinator-led outreach, structured process redesign, enhanced donor education, and continuous quality improvement initiatives. Follow-up rates also remained robust during the COVID-19 pandemic despite the transition to telephone-based consultations. CONCLUSION: A centralized, quality-driven national framework can achieve durable, high-level adherence to long-term follow-up among living kidney donors, even amid rapid program expansion. This scalable model provides a strong foundation for registry-based outcome monitoring and evidence-informed donor care.