TY - JOUR
T1 - The Role of Procurement Biopsies in Kidney Acceptance Decision Making and Kidney Discard
T2 - Perceptions of Physicians, Nurse Coordinators, and OPO Staff and Directors
AU - Schantz, Karolina
AU - Gordon, Elisa J.
AU - Lee, Unsun
AU - Rocha, Maria
AU - Friedewald, John
AU - Ladner, Daniela P.
AU - Becker, Yolanda
AU - Formica, Richard
AU - Reese, Peter P.
AU - Kaufman, Dixon
AU - Barah, Masoud
AU - Walker, Marissa
AU - Mehrotra, Om
AU - Viveros, Dania
AU - Mehrotra, Sanjay
N1 - Funding Information:
This research is funded by the National Institutes of Health (1R01DK118425-01A1). The principal investigator is S.M.
Publisher Copyright:
Copyright © 2022 The Author(s). Transplantation Direct. Published by Wolters Kluwer Health, Inc.
PY - 2022/3/10
Y1 - 2022/3/10
N2 - Background.: Procurement biopsies suffer from challenges with quality and reproducibility and are linked to kidney discard. Nonetheless, procurement biopsies are obtained for the majority of kidneys in the United States, and biopsy findings are commonly relied upon in kidney acceptance decisions. Methods.: We conducted in-depth, semistructured interviews with 30 surgeons, nephrologists, nurse coordinators, and organ procurement organization (OPO) staff and directors to assess perceptions of factors contributing to kidney discard and strategies to reduce kidney discard, with a focus on the role of procurement biopsies. Thematic analysis was used to analyze qualitative data. Results.: Three main themes emerged: (1) participants emphasized the importance of biopsy findings in making acceptance decisions but expressed concerns about a lack of standardization and quality control; (2) participants reported large variations in the level of importance placed on biopsy findings, the level of reliance on glomerulosclerosis in particular, and the cutoffs used; and (3) participants disagreed about how often procurement biopsies should be taken, with some supporting stricter limits on which kidneys are biopsied and others preferring a biopsy for most kidney offers. Conclusions.: These findings support the development of standard practices for which kidneys require biopsy, how the biopsy material is prepared, and how the biopsy is interpreted. Variability in kidney acceptance practices across centers and the use of biopsy findings in guiding recipient selection also lend support to policies to allocate kidneys with suboptimal histological findings to the centers that are willing to use such kidneys and the patients who could most benefit from such offers.
AB - Background.: Procurement biopsies suffer from challenges with quality and reproducibility and are linked to kidney discard. Nonetheless, procurement biopsies are obtained for the majority of kidneys in the United States, and biopsy findings are commonly relied upon in kidney acceptance decisions. Methods.: We conducted in-depth, semistructured interviews with 30 surgeons, nephrologists, nurse coordinators, and organ procurement organization (OPO) staff and directors to assess perceptions of factors contributing to kidney discard and strategies to reduce kidney discard, with a focus on the role of procurement biopsies. Thematic analysis was used to analyze qualitative data. Results.: Three main themes emerged: (1) participants emphasized the importance of biopsy findings in making acceptance decisions but expressed concerns about a lack of standardization and quality control; (2) participants reported large variations in the level of importance placed on biopsy findings, the level of reliance on glomerulosclerosis in particular, and the cutoffs used; and (3) participants disagreed about how often procurement biopsies should be taken, with some supporting stricter limits on which kidneys are biopsied and others preferring a biopsy for most kidney offers. Conclusions.: These findings support the development of standard practices for which kidneys require biopsy, how the biopsy material is prepared, and how the biopsy is interpreted. Variability in kidney acceptance practices across centers and the use of biopsy findings in guiding recipient selection also lend support to policies to allocate kidneys with suboptimal histological findings to the centers that are willing to use such kidneys and the patients who could most benefit from such offers.
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U2 - 10.1097/TXD.0000000000001299
DO - 10.1097/TXD.0000000000001299
M3 - Article
C2 - 35310603
AN - SCOPUS:85128150771
SN - 2373-8731
VL - 8
SP - E1299
JO - Transplantation Direct
JF - Transplantation Direct
IS - 4
ER -