Special ArticleNephrologists' Perspectives on Waitlisting and Allocation of Deceased Donor Kidneys for Transplant
Section snippets
Context
In Australia, the nephrologist makes a recommendation about patient suitability for transplant based on medical and psychosocial considerations. Potential transplant candidates also are reviewed independently by a transplant assessment team that includes nephrologists, allied health staff, anesthetists, and surgeons. Allocation of deceased donor kidneys is determined by a computer program called the National Organ Matching System.9 The major criteria used in the algorithm are time on waiting
Results
Of 28 invited nephrologists, 25 (89%) participated in the study. Nonparticipation was due to travel and clinical commitments. Participant characteristics are listed in Table 1. On average, each interview lasted 30-90 minutes. Participants were from New South Wales (n = 12), Queensland (n = 2), South Australia (n = 6), Victoria (n = 3), and Western Australia (n = 2). Most participants were men (n = 20). Twenty practiced in a transplant center; 3, in a nephrology (nontransplant) center; and 2, in
Discussion
Nephrologists viewed their primary responsibility as being to their own patients, in which they empowered patients to achieve the required threshold for waitlist suitability based on adherence, weight, and cessation of smoking. Nephrologists made decisions to waitlist and accept a donated kidney mainly based on medical status, potential for improved health outcomes, psychological factors, and patient preferences. They also sought to uphold professional integrity by maintaining transparency in
Acknowledgements
We thank all the nephrologists for taking the time to share their thoughtful and insightful perspectives on waitlisting patients for transplant and on organ allocation.
Support: This project is supported by the Australian Research Council Discovery Project Grant DP 0985187. Dr Tong is supported by the National Health and Medical Research Council (NHMRC) Capacity Building Grant in Population Health ID 457281. The study sponsor had no role in study design; collection, analysis, and interpretation
References (26)
- et al.
The impact of waiting time and comorbid conditions on the survival benefit of kidney transplantation
Kidney Int
(2005) The development of kidney allocation policy
Am J Kidney Dis
(2005)- et al.
Determinants of transplant surgeons' willingness to provide organs to patients infected with HBV, HCV or HIV
Am J Transplant
(2005) - et al.
“Old-for-old” cadaveric renal transplantation: surgical findings, perioperative complications and outcome
Eur Urol
(2003) - et al.
Evaluation of the Eurotransplant Senior ProgramThe results of the first year
Am J Transplant
(2002) - et al.
Kidneys from deceased donors: maximizing the value of a scarce resourc
Am J Transplant
(2005) - et al.
Moving kidney allocation forward: the ASTS perspective
Am J Transplant
(2009) - et al.
Survival in recipients of marginal cadaveric donor kidneys compared with other recipients and wait-listed transplant candidates
J Am Soc Nephrol
(2001) - et al.
Survey of patient selection for cadaveric renal transplantation in the United Kingdom
Nephrol Dial Transplant
(1995) - et al.
U.S. nephrologists' attitudes towards renal transplantation: results from a national survey
Transplantation
(2001)
Decision-making about suitability for kidney transplantation: results of a national survey of Australian nephrologists
Nephrology
Impact of the expanded criteria donor allocation system on the use of expanded criteria donor kidneys
Transplantation
The evaluation of candidates for renal transplantationThe current practice of U.S. transplant center
Transplantation
Cited by (29)
Considerable Variability Among Transplant Nephrologists in Judging Deceased Donor Kidney Offers
2023, Kidney International ReportsComparing preferences of physicians and patients regarding the allocation of donor organs: A systematic review
2020, Transplantation ReviewsCitation Excerpt :Amongst the nine quantitative studies, seven studies used (self-administered) questionnaires [18–20,22,26,29,31], whereas one study was a DCE [25] and another one used both, a questionnaire and a DCE [24]. In the group of the qualitative studies, four used (semi-structured) (phone-) interviews [21,23,27,28]. The last study used focus group discussions [30].
Is social support associated with post-transplant medication adherence and outcomes? A systematic review and meta-analysis
2018, Transplantation ReviewsCitation Excerpt :Clinical guidelines issued by the Centers for Medicare and Medicaid Services (CMS) and professional societies provide explicit recommendations for use of medical, demographic, psychological, and lifestyle factors to assist transplant centers in determining eligibility and balancing equity and efficiency [3–8]. However, vague CMS guidelines have raised concerns about potential ambiguity and lack of evidence for some waitlist criteria, including social support [9–12]. Lack of specificity regarding social support definitions and acceptable support thresholds has resulted in significant variation in transplant centers' approaches to using social support to determine eligibility.
Increase kidney transplant: Guidelines of Haute Autorité de Santé
2014, Nephrologie et TherapeutiqueAchieving fairness in access to kidney transplant: A work in progress
2011, American Journal of Kidney DiseasesBalancing Equity and Efficiency in Kidney Allocation: An Overview
2022, Cambridge Quarterly of Healthcare Ethics
Originally published online August 24, 2011.