Allocation of Deceased Donor Kidneys for Transplantation: Opinions of Patients With CKD

Background: Deceased donor kidney allocation schemes are designed to balance optimal utility with equity of access. The aim of this single-center survey is to seek patient opinion about the relative importance of factors used to determine the optimal transplant recipient in kidney allocation schemes...

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Bibliographic Details
Published in:	American journal of kidney diseases Vol. 46; no. 5; pp. 949 - 956
Main Authors:	Geddes, Colin C., Rodger, R. Stuart C., Smith, Christopher, Ganai, Anita
Format:	Journal Article
Language:	English
Published:	Orlando, FL Elsevier Inc 01-11-2005 Elsevier
Subjects:	Adolescent Adult Age Factors Aged Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences Cadaver Child Chronic Disease Data Collection deceased donor Emergency and intensive care: renal failure. Dialysis management equity of access Female Graft Survival hemodialysis (HD) HLA mismatch Humans Intensive care medicine Kidney Diseases - psychology Kidney Failure, Chronic - surgery Kidney Failure, Chronic - therapy Kidney transplantation Kidney Transplantation - ethics Kidney Transplantation - psychology Male Medical sciences Middle Aged Nephrology. Urinary tract diseases organ allocation patient opinion Patient Selection - ethics Patients - psychology questionnaire recipient age recipient sex Renal Dialysis - psychology Sex Factors Social Justice Surveys and Questionnaires Tissue and Organ Procurement - ethics Tissue and Organ Procurement - standards Tissue Donors Transplants - ethics Transplants - supply & distribution United Kingdom United States utility Waiting Lists waiting time recipient age waiting time questionnaire deceased donor patient opinion recipient sex hemodialysis (HD) HLA mismatch utility equity of access organ allocation Kidney transplantation Nephrology Questionnaire Accessibility Hemodialysis Sex Equity Transplantation Waiting time Kidney Urology Extrarenal dialysis Surgery Graft Age Human Recipient Treatment Urinary system Donor Histocompatibility Organ
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Summary:	Background: Deceased donor kidney allocation schemes are designed to balance optimal utility with equity of access. The aim of this single-center survey is to seek patient opinion about the relative importance of factors used to determine the optimal transplant recipient in kidney allocation schemes. Methods: In each of 8 scenarios, participants were invited to select which 1 of 2 hypothetical patients should receive a kidney. Results: Two hundred thirty-two of 295 invited patients (78.6%) completed the questionnaire: 104 of 153 invited hemodialysis patients (68.0%) and 128 of 142 invited patients with functioning transplants (90.1%). Only 6.0% of participants agreed with current UK Transplant (UKT) and United Network for Organ Sharing (UNOS) allocation to a patient not yet on dialysis therapy who had been on the transplant waiting list longer than a patient already on dialysis therapy. Only 24.6% of participants agreed with the UKT and UNOS schemes that the transplant survival advantage associated with HLA matching warranted allocation of a kidney to a patient who had been waiting 2 years in preference to a patient waiting 7 years. Participants also were opposed to the use of recipient age and balance of exchange agreements (that reward centers with high rates of organ retrieval). The majority agreed with UKT and UNOS that recipient sex should not be used to allocate kidneys and allocation should favor recipients who have waited longer. Conclusion: Patients disagreed with several aspects of current allocation systems. Analysis of patient opinion should be taken into consideration when attempting to optimize the use of this scarce health resource.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0272-6386 1523-6838
DOI:	10.1053/j.ajkd.2005.07.031