Living kidney donations: addressing disparities using human-centered design
Living kidney donations: addressing disparities using human-centered design
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Discovery Research and UX Design
Discovery Research and UX Design
Role: Lead UX Researcher, Content Strategist
Research Methods: Competitive Analysis, Analytics, Heatmapping, Interviews, Cross-functional team workshops, Usability Testing
Project Team: Raghav Wusirika M.D., Sheryl Williams, Kama Carranza, Sethlany Harris, Erika Best, Dedrick Sprick, Eva Wong, Megan Fairbank, Carla Justice, Kathleen Gardiner, Jessica Chin
Tools: Hotjar, Qualtrics, Google Analytics, Figma, Miro, Webex
The problem:
The problem:
Through coursework for a human-centered design class, Dr. Wusirika discovered disparities between patients most likely to get a living kidney donation versus not. In the U.S., living kidney donations are not cost neutral. Out-of-pocket costs for travel, time off work, and caretaking assistance are estimated to be between $1,000-$20,000 for donors. In addition, donating a kidney comes with inherent risks to the donor. The OHSU clinical transplant website was not making it clear for someone interested in or curious about donating a kidney to understand the process, the risks, the costs, and the resources available up front so they could decide if donating is an option for them.
Through coursework for a human-centered design class, Dr. Wusirika discovered disparities between patients most likely to get a living kidney donation versus not. In the U.S., living kidney donations are not cost neutral. Out-of-pocket costs for travel, time off work, and caretaking assistance are estimated to be between $1,000-$20,000 for donors. In addition, donating a kidney comes with inherent risks to the donor. The OHSU clinical transplant website was not making it clear for someone interested in or curious about donating a kidney to understand the process, the risks, the costs, and the resources available up front so they could decide if donating is an option for them.
Research Questions
Research Questions
What questions may potential donors have about what it's like to donate a kidney?
What barriers may potential donors face when considering donating a kidney?
What information is imperative for potential donors to understand before submitting an application of interest to become a living kidney donor?
What resources at OHSU and outside OHSU are available for potential donors to utilize? How can we make those findable?
The Process: Human-Centered Design
The Process: Human-Centered Design
What is: interviews and personas
What is: interviews and personas
To understand the living kidney donation process and experience, Dr. Wusirika conducted interviews with members of the transplant team, as well as patients awaiting donations and their family members.
The team created a target persona that represented the type of donor who is most likely to face difficulties when donating a kidney.
The team journey mapped the donor persona beginning when they learn a friend/family member needs a kidney through donation and recovery.
What if: ideating and affinity mapping
What if: ideating and affinity mapping
Journey mapping gave the team an understanding of the pain points that donors face throughout the living donation process. This understanding opened opportunities to create potential solutions. The team grouped solutions and found six categories:
Financial assistance
Patient experience
Technical support
Communication support
Process mapping
Gaps in internal processes
What wows: converging ideas and prototyping
What wows: converging ideas and prototyping
As a team, we used the research questions as guides to converge and develop a content design strategy that would bring value to people considering living donation.
The content was then co-designed in workshops where the team, including providers and coordinators, sketched their ideas and voted on designs to include.
What works: interviews and usability testing
What works: interviews and usability testing
We talked to people who fit the characteristics of our target persona. Questions included, "If a donor were here answering questions about their experience, what, if anything, would you want to know?"
We then asked participants if they could find the answers to their questions on the prototyped webpage. We watched how they interacted with the page, taking note of gaps in the content and design.
We used the findings of the remaining gaps to iterate on the page, refining the content and design.
Process adapted from Solving Problems with Design Thinking, 2013 Jeanne Liedtka, Andrew King and Kevin Bennett
Key Qualitative Insights
Key Qualitative Insights
We learned that most "low" pain points occur at the beginning when potential donors are curious about what it takes to apply. They are looking for information about
Process - what is expected of me? How long does it take? When can I donate?
Recovery and aftercare - how long does recovery take? What standard of living can I expect after donating?
Cost: does insurance cover this? What does aftercare look like and what can I afford?
After interacting with the webpage, potential donors expressed feeling like the page answered the questions they had. However, we also learned that some people developed questions and feelings of fear and uncertainty. In addition to all the details outlined above, 4/5 participants shared they would want to learn from prior donors about their experience with donation, positive and negative ones. We used this information to gather honest patient "testimonials" to include on the page. We also included information about how OHSU can help connect interested donors with previous donors to learn about their experiences.
The Solution
The Solution
An honest, transparent page with information that answers all the questions a person may have when considering living kidney donations. We understand that donation is a very difficult decision that should not be made lightly. Our goal was not to convince people to donate, but rather to inform them.
Learning about living kidney donations - types of donations, and who can donate.
What to expect - the donor application process, screenings, and privacy.
Costs - what is covered by the recipient's insurance and what is not, and what other costs should be anticipated.
Resources - financial, housing, and support resources, including how to contact previous donors.
About the team - pictures of the coordinators and advocates who are available to help donors at every step of the donation process, and links to provider profiles so they can learn about the team.
Contact information
Results and Impact
Results and Impact
In the 200 days after launch, compared to the same period the year prior:
In the 200 days after launch, compared to the same period the year prior:
An 81% increase in page views. Some of these views may be from ourselves and our colleagues taking a look.
A 98% increase in unique visitors ono the page, indicating it is reaching more folks and/or getting shared more than it was last year.
A 139% increase in engagement time, from 56 seconds to 2+ minutes. This indicates people are taking time to read the content.
Total conversions on the page increased by 37.92%. This includes click-to-call and click-to-e-mail, which indicates more people are inquiring about applying to become a donor.
Feedback from the coordinators 100 days after launch: "Yay!!! It feels like we have gotten a lot more emails inquiring about how to start the process."
In the news
In the news
Though it is unlikely that the website was solely responsible for the success of the clinical transplant program in 2023, the above analytics are consistent with OHSU's increase in living kidney donations for that year.
Future Opportunities
Future Opportunities
The clinical transplant team will collect data on rates of living donation by donation type before and after the new webpage went live to evaluate if the page potentially helped close the gap between Medicaid/Medicare and private insurance recipients receiving living kidney donations. If not, the team will continue to iterate on other solutions.
As part of a website redesign project, we hope OHSU will implement a workflow that will allow the page and the entire website to be translated into other languages.
When we tested the webpage, there was a section at the top of the page that broke down the contents of the page. We observed that once participants started scrolling on the page, some would go back to the top to reference all the sections. We think that this top navigation was orienting for users, however, we had limitations within our content management system. Unfortunately, we were unable to include it in the final design. We currently have a ticket in the backlog for development time to build it, and hope we can get support in adding it to the page soon!
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