Transitioning to a New Lab for HLA Testing: Impact on Workflow and Time to Donor Selection

Topic Significance & Study Purpose/Background/Rationale HLA typing is key to timely donor identification, collection, and allogeneic transplant. To minimize time to donor selection and increase program efficiency, our site adjusted workflows and transitioned to a new lab. Methods, Intervention, & Analysis The previous workflow for HLA typing was as follows: Related donors residing in-state had labs drawn in clinic and completed a paper form prepared by the Transplant Coordinators (TC's); specimens were sent to “Lab A”. Related donors residing out-of-state received a swab kit prepared by TC's. For unrelated donor samples collected through the National Marrow Donor Program (NMDP), TC's sent GRID numbers with corresponding patient information to Lab A to ensure results were paired appropriately. Results were faxed in 10-14 business days of sample receipt. NMDP Form 22’s were submitted by TC's. Multiple changes accompanied switching to “Lab B”. TC's now request swab kits to be mailed from Lab B to all related donors. NMDP and Lab B systems are linked, thus TC's need not communicate patient/GRID associations or submit Form 22s. Results are posted to a secure website within 5 business days of sample receipt. To support the change to Lab B, the HLA order process for patients was revised. Training was conducted with inpatient and outpatient nurses, lab staff, and phlebotomists. Lab B conducted training with Transplant Coordinators on how to utilize their website. Findings & Interpretation Since changing to Lab B in March 2023, time to HLA results was halved. Retrieving results from an online portal facilitated status checks, clarified reporting dates, eliminated lost faxes and enabled access from any location. The elimination of select TC responsibilities has enabled increased caseload. The number of tubes required for patient typing decreased. Workflows continue to evolve. The electronic HLA order set is not yet finalized. NMDP collection centers still occasionally send samples to Lab A. Discussion & Implications Obtaining HLA results quickly on a user-friendly, web-based platform has improved time to donor identification and streamlined workflows to enable increased transplant capacity.