Prioritising patients for renal transplantation? Analysis of patient preferences for kidney allocation according to ethnicity and gender (original) (raw)
Related papers
BMC Nephrology, 2012
Background: Policies for allocating deceased donor kidneys have recently shifted from allocation based on Human Leucocyte Antigen (HLA) tissue matching in the UK and USA. Newer allocation algorithms incorporate waiting time as a primary factor, and in the UK, young adults are also favoured. However, there is little contemporary UK research on the views of stakeholders in the transplant process to inform future allocation policy. This research project aimed to address this issue. Methods: Discrete Choice Experiment (DCE) questionnaires were used to establish priorities for kidney transplantation among different stakeholder groups in the UK. Questionnaires were targeted at patients, carers, donors / relatives of deceased donors, and healthcare professionals. Attributes considered included: waiting time; donor-recipient HLA match; whether a recipient had dependents; diseases affecting life expectancy; and diseases affecting quality of life.
The Role of Heterogeneity of Patients’ Preferences in Kidney Transplantation
SSRN Electronic Journal
We elicit time and risk preferences for kidney transplantation from the entire population of patients of the largest Italian transplant centre using a discrete choice experiment (DCE). We measure patients' willingness-to-wait (WTW), expressed in months, for receiving a kidney with one-year longer expected graft survival, or low risk of complication. Using a mixed logit in WTW-space model, we find heterogeneity in patients' preferences. Our model allows WTW to vary with the patient's age and duration of dialysis. The results suggest that WTW correlates with age and duration of dialysis. The implication for transplant practice is that including individual preferences in kidney allocation protocols that assign "non-ideal" (expanded donor criteria) organs may not only increase the expected survival rates of patients with transplanted organs but also improve patients' satisfaction.
Patients' views in the choice of renal transplant
Kidney International, 1996
Patients' views in the choice of renal transplant. Little is known about chronic dialysis patients' reasons for electing renal transplantation. We investigated chronic dialysis patients' reasons for choosing to be listed or not listed for renal transplantation. Chronic dialysis patients were asked to complete a questionnaire consisting of demographic information and questions related to desire for transplantation and previous transplant experience. The mean age of the dialysis population was 48 15 years (range 16 to 81 years); the population was 61% women, 39% African American, and 26% diabetic. The questionnaires of the 95 patients eligible for transplantation were analyzed. Forty-four percent of the eligible patients were active on a transplant waiting list; 56% of patients refused transplantation. Twenty-nine percent of the surveyed patients had had at least one previous transplant. Listed patients were younger (43 vs. 52 years), had fewer years of ESRD (5 vs. 9 years), and were more likely to be on home dialysis therapy (55% vs. 32%). There were no differences between listed and unlisted patients in gender, race, years of education, marital status, children, diabetes mellitus, and previous transplant experience. African American patients reporting strong religious beliefs were less likely to be listed for transplantation (76% vs. 24%); religious beliefs were not related to white patients' listing for transplantation. The most reported reason for electing transplantation was "hoping for a better quality of life" (86% of respondents). More never-transplanted patients elected transplantation "hoping it will make me live longer" (69% vs. 25% with previous transplant) and because their doctor (50% vs. 6%) or family (42% vs. 6%) thought it was a good idea. Of patients who declined transplant, 92% with previous transplant experience indicated that the experience discouraged them from seeking retransplantation; 59% of patients without transplant experience reported that seeing what happened to others with a failed transplant affected their decision not to seek transplantation. Our findings suggest that race and gender differences in electing transplant may disappear when all patients are actively solicited for transplantation. However, older patients may be less likely to elect transplant because they are more satisfied with life on dialysis or less willing to take risks. Further study of patients' reasons for electing transplantation is required before demographic variations in transplant choices can be accurately interpreted.
Community values and preferences in transplantation organ allocation decisions
Social science & medicine, 2001
This paper is concerned with community values and preferences in organ transplantation allocation decisions. With recent trends in organ shortages, transplant teams face difficult allocation decisions amongst increasing numbers of ''worthy'' potential recipients. It is argued that the debate about these decisions ought to be informed in part by a systematic knowledge of prevailing community standards. A community sample of 238 adults (140 women and 98 men, with a mean age of 47.0 years) completed a questionnaire concerning which factors ought to affect recipient priority for transplantation. Longer waiting time, better prognosis, younger age and being a parent were the most frequently selected criteria for organ allocation decisions. The participants also rank ordered 16 potential recipients presented in the form of case scenarios in terms of priority for transplantation. The 16 case scenarios were constructed from a factorial combination of four variables: age of recipient (young vs old); the time the recipient had been on a waiting list (long vs short); recipient prognosis (excellent vs fair); and parental status (children vs no children). It was found that one case scenario involving a young parent with an excellent prognosis and long waiting time was ranked first by 75.2% of all participants. Analysis revealed that transplant recipient age and prognosis were the most influential factors in determining the priority rankings for organ allocation. The study has demonstrated that judgement and decision analysis procedures can be used to elicit community values and preferences about complex resource allocation decisions. #
Racial and Socioeconomic Disparities in the Allocation of Expanded Criteria Donor Kidneys
Clinical Journal of the American Society of Nephrology, 2013
Background and objectives In carefully selected individuals, receiving expanded criteria donor (ECD) kidneys confer a survival advantage over remaining on dialysis. However, wait lists for ECD kidneys often include a significant proportion of young patients, who have no predictable survival benefit from ECD kidneys. This study hypothesized that educational and socioeconomic factors might influence a younger patient's decision to accept an ECD kidney.
JAMA Surgery
IMPORTANCE Inactive patients on the kidney transplant wait-list have a higher mortality. The implications of this status change on transplant outcomes between racial/ethnic groups are unknown. OBJECTIVES To determine if activity status changes differ among races/ethnicities and levels of sensitization, and if these differences are associated with transplant probability after implementation of the Kidney Allocation System. DESIGN, SETTING, AND PARTICIPANTS A multistate model was constructed from the Organ Procurement and Transplantation Network kidney transplant database (December 4, 2014, to September 8, 2016). The time interval followed Kidney Allocation System implementation and provided at least 1-year follow-up for all patients. The model calculated probabilities between active and inactive status and the following competing risk outcomes: living donor transplant, deceased donor transplant, and death/other. This retrospective cohort study included 42 558 patients on the Organ Procurement and Transplantation Network kidney transplant wait-list following Kidney Allocation System implementation. To rule out time-varying confounding from relisting, analysis was limited to first-time registrants. Owing to variations in listing practices, primary center listing data were used for dually listed patients. Individuals listed for another organ or pancreatic islets were excluded. Analysis began July 2017. MAIN OUTCOME AND MEASURES Probabilities were determined for transitions between active and inactive status and the following outcome states: active to living donor transplant, active to deceased donor transplant, active to death/other, inactive to living donor transplant, inactive to deceased donor transplant, and inactive to death/other. RESULTS The median (interquartile range) age at listing was 55.0 (18.0-89.0) years, and 26 535 of 42 558 (62.4%) were men. White individuals were 43.3% (n = 18 417) of wait-listed patients, while black and Hispanic individuals made up 27.8% (n = 11 837) and 19.5% (n = 8296), respectively. Patients in the calculated plasma reactive antibody categories of 0% or 1% to 79% showed no statistically significant difference in transplant probability among races/ethnicities. White individuals had an advantage in transplant probability over black individuals in calculated plasma reactive antibody categories of 80% to 89% (hazard ratio [HR], 1.8 [95% CI, 1.4-2.2]) and 90% or higher (HR, 2.4 [95% CI, 2.1-2.6]), while Hispanic individuals had an advantage over black individuals in the calculated plasma reactive antibody group of 90% or higher (HR, 2.5 [95% CI, 2.1-2.8]). Once on the inactive list, white individuals were more likely than Hispanic individuals (HR, 1.2 [95% CI, 1.17-1.3]) or black individuals (HR, 1.4 [95% CI, 1.3-1.4]) to resolve issues for inactivity resulting in activation. CONCLUSIONS AND RELEVANCE For patients who are highly sensitized, there continues to be less access to kidney transplant in the black population after the implementation of the Kidney Allocation System. Health disparities continue after listing where individuals from minority groups have greater difficulty in resolving issues of inactivity.
Modifiable Factors in Access to Living-Donor Kidney Transplantation Among Diverse Populations
Transplantation Journal, 2013
Background. We have observed a significant inequality in the number of living-donor kidney transplants (LDKT) performed between patients of non-Western European origin and those of Western European origin. The aim of this study was to investigate modifiable factors that could be used as potential targets for an intervention in an attempt to reduce this inequality. Methods. A questionnaire on knowledge, risk perception, communication, subjective norm, and willingness to accept LDKT was completed by 160 end-stage renal patients who were referred to the pretransplantation outpatient clinic (participation rate of 92%). The questionnaire was available in nine languages. Multivariate analyses of variance were conducted to explore differences between patients with and without a living donor.
Racial differences in completion of the living kidney donor evaluation process
Clinical transplantation, 2018
Racial disparities in living donor kidney transplantation (LDKT) persist but the most effective target to eliminate these disparities remains unknown. One potential target could be delays during completion of the live donor evaluation process. We studied racial differences in progression through the evaluation process for 247 African American (AA) and 664 non-AA living donor candidates at our center between January 2011 and March 2015. AA candidates were more likely to be obese (38% vs 22%: P < .001), biologically related (66% vs 44%: P < .001), and live ≤50 miles from the center (64% vs 37%: P < .001) than non-AAs. Even after adjusting for these differences, AAs were less likely to progress from referral to donation (aHR for AA vs non-AA: 0.47 P = .01). We then assessed racial differences in completion of each step of the evaluation process and found disparities in progression from medical screening to in-person evaluation (aHR: 0.62 P = .02) and from clearance to donation...
Racial and ethnic disparities in kidney transplantation
Transplant International, 2010
Success of renal transplantation, as a viable alternative to dialysis, has been tempered by long-standing racial disparities. Ethnic minorities have less access to transplantation, are less likely to be listed for transplantation, and experience a higher rate of graft failure. Reasons for the existing racial disparities at various stages of the transplantation process are complex and multi-factorial. They include a combination of behavioral, social, environmental, and occupational factors, as well as potential intended or unintended discrimination within the healthcare system. Immunologic factors such as human leukocyte antigen matching, composition of the organ donor pool, and patient immune response, all of which affect post-transplantation graft rejection rates and patient survival, also contribute to health disparities between ethnic groups.