Physician and patient acceptance of policies to reduce kidney discard

Sanjay Mehrotra; Karolina Schantz; John J. Friedewald; Daniela P. Ladner; Yolanda Becker; Richard Formica; Masoud Barah; Jiayi Gu; Elisa J Gordon

doi:10.1111/ctr.14054

Physician and patient acceptance of policies to reduce kidney discard

Sanjay Mehrotra^*, Karolina Schantz, John J. Friedewald, Daniela P. Ladner, Yolanda Becker, Richard Formica, Masoud Barah, Jiayi Gu, Elisa J Gordon

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

Despite the shortage of kidneys for transplantation in the United States, approximately 18%-20% of deceased donor kidneys are discarded each year. These discarded kidneys can offer a survival benefit to suitable patients. Revisions to the current kidney allocation policy may be needed to reduce deceased donor kidney discard. We surveyed transplant physicians and patients to assess their perceived acceptability of policy proposals to reduce the discard of deceased donor kidneys. Members of professional societies (AST, ASTS) and a patient organization (AAKP) were invited to complete the survey. Responses were obtained from 97 physicians and 107 patients. The majority of physicians (73.4%) and patients (73.8%) "somewhat" or "completely" accepted a policy for fast-tracking kidneys at risk of discard. Physicians and patients also supported returning a proportion of waiting time to patients who accept KDPI >85 kidneys and experience graft failure within the first 12 months, with 36% of physicians and 50% of patients electing to return 100% of the waiting time. The majority of physicians (75%) "somewhat or completely" accepted a policy to skip less aggressive centers for KDPI 90 + offers. Physicians and patients provided insights into factors researchers, and policymakers should consider in the design and implementation of these policies.

Original language	English (US)
Article number	e14054
Journal	Clinical Transplantation
Volume	34
Issue number	11
DOIs	https://doi.org/10.1111/ctr.14054
State	Published - Nov 2020

Funding

This research is funded by the National Institutes of Health 1R01DK118425-01A1. The principal investigator is Sanjay Mehrotra. The authors would like to thank the American Society of Transplant Surgeons, The American Society of Transplantation, and the American Association of Kidney Patients for giving us the opportunity to disseminate the survey to their members. The authors would also like to thank physicians at the Northwestern Comprehensive Transplant Center (Dr Javeed Ansari, Dr Daniel Borja, and Dr Aneesha Shetty) and members of the Northwestern Transplant Village for their support with cognitive testing the survey instruments. This research is funded by the National Institutes of Health 1R01DK118425‐01A1. The principal investigator is Sanjay Mehrotra. The authors would like to thank the American Society of Transplant Surgeons, The American Society of Transplantation, and the American Association of Kidney Patients for giving us the opportunity to disseminate the survey to their members. The authors would also like to thank physicians at the Northwestern Comprehensive Transplant Center (Dr Javeed Ansari, Dr Daniel Borja, and Dr Aneesha Shetty) and members of the Northwestern Transplant Village for their support with cognitive testing the survey instruments.

Keywords

ethics
kidney allocation
kidney transplantation
policy

ASJC Scopus subject areas

Transplantation

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Cite this

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abstract = "Despite the shortage of kidneys for transplantation in the United States, approximately 18%-20% of deceased donor kidneys are discarded each year. These discarded kidneys can offer a survival benefit to suitable patients. Revisions to the current kidney allocation policy may be needed to reduce deceased donor kidney discard. We surveyed transplant physicians and patients to assess their perceived acceptability of policy proposals to reduce the discard of deceased donor kidneys. Members of professional societies (AST, ASTS) and a patient organization (AAKP) were invited to complete the survey. Responses were obtained from 97 physicians and 107 patients. The majority of physicians (73.4%) and patients (73.8%) {"}somewhat{"} or {"}completely{"} accepted a policy for fast-tracking kidneys at risk of discard. Physicians and patients also supported returning a proportion of waiting time to patients who accept KDPI >85 kidneys and experience graft failure within the first 12 months, with 36% of physicians and 50% of patients electing to return 100% of the waiting time. The majority of physicians (75%) {"}somewhat or completely{"} accepted a policy to skip less aggressive centers for KDPI 90 + offers. Physicians and patients provided insights into factors researchers, and policymakers should consider in the design and implementation of these policies.",

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Physician and patient acceptance of policies to reduce kidney discard

Abstract

Funding

Keywords

ASJC Scopus subject areas

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