Attitudes of Minority Patients with End‐Stage Renal Disease Regarding ABO‐Incompatible List‐Paired Exchanges

• Published in: American journal of transplantation Vol. 6; no. 1; pp. 83 - 88
• Main Authors: Ackerman, P. D., Thistlethwaite, J. R., Ross, L. F.
• Format: Journal Article
• Language: English
• Published: Oxford UK Munksgaard International Publishers 01-01-2006; Blackwell
• Subjects: ABO Blood-Group System - immunology; Adolescent; Adult; Aged; Aged, 80 and over; Attitude to Health - ethnology; Attitudes; Biological and medical sciences; Directed Tissue Donation - ethics; Female; Histocompatibility - ethics; Humans; kidney exchange; Kidney Failure, Chronic - ethnology; Kidney Failure, Chronic - psychology; Kidney Failure, Chronic - therapy; Kidney Transplantation - ethics; Kidney Transplantation - ethnology; list‐paired exchange; Living Donors - psychology; Living Donors - supply & distribution; living paired exchange; Male; Medical sciences; Middle Aged; minority; Minority Groups - psychology; Nephrology. Urinary tract diseases; Nephropathies. Renovascular diseases. Renal failure; Renal failure; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; transplantation; Waiting Lists; Kidney disease; Human; Incompatibility; Urinary system disease; Attitude; ABO(H)-System; Attitudes; Patient; Transplantation; living paired exchange; Homotransplantation; kidney exchange; Exchange; Blood group; Treatment; Surgery; Minority; Renal failure; Graft; List; list-paired exchange
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2005.01122.x

A few transplant centers in the United States have implemented list‐paired exchange programs that include both ABO‐compatible and ABO‐incompatible living‐donor recipients. ABO‐incompatible list‐paired exchanges raise ethical concerns because they increase the total number of organs available but increase the waiting time for wait‐list candidates of blood type O. In this manuscript, we explore attitudes of a convenience sample of minority patients with end‐stage renal disease (ESRD) regarding living paired exchanges, ABO‐compatible and ABO‐incompatible list‐paired exchanges and ABO‐incompatible direct transplants. Data from 87 minority respondents were analyzed. Eighty‐seven (100%) supported living paired exchanges and ABO‐compatible list‐paired exchanges. In contrast, only 50 of 85 (59%) respondents supported ABO‐incompatible list‐paired exchanges (p < 0.001), including half (12 of 24) of those with blood type O. Subjects were asked how much additional time it would be fair to ask wait‐list candidates of blood type O to wait to implement ABO‐incompatible list‐paired exchanges. Forty percent (35 of 87) responded ‘no additional time’ and another 10% (9 of 87) responded ‘one month or shorter’. Minority dialysis patients hold mixed opinions about the fairness of ABO‐incompatible list‐paired exchanges. If our findings are confirmed in a more diverse randomly selected sample, then the UNOS variances that permit these exchanges should be reconsidered.