Patient preferences for the allocation of deceased donor kidneys for transplantation: a mixed methods study

BMC Nephrology

Research Article

Steve Chadban¹  Niamh Marren²  Stephen Jan³  Alan Cass³  Kirsten Howard⁴  Michelle Irving⁵  Jonathan C Craig⁵  Allison Tong⁵  Germaine Wong⁶ 

[1] Central Clinical School, Bosch Institute, The University of Sydney, 2006, Sydney, NSW, Australia;Centre for Kidney Research, The Children's Hospital at Westmead, 2145, Sydney, NSW, Australia;Renal and Metabolic Division, The George Institute for Global Health, 2050, Sydney, NSW, Australia;Sydney School of Public Health, The University of Sydney, 2006, Sydney, NSW, Australia;Sydney School of Public Health, The University of Sydney, 2006, Sydney, NSW, Australia;Centre for Kidney Research, The Children's Hospital at Westmead, 2145, Sydney, NSW, Australia;Sydney School of Public Health, The University of Sydney, 2006, Sydney, NSW, Australia;Centre for Kidney Research, The Children's Hospital at Westmead, 2145, Sydney, NSW, Australia;Centre for Transplant and Renal Research, Westmead Hospital, 2145, Sydney, NSW, Australia;

关键词: Dialysis Patient;    Graft Loss;    Kidney Transplant Recipient;    Deceased Donor;    Importance Score;   

DOI  :  10.1186/1471-2369-13-18

 received in 2011-11-17, accepted in 2012-04-18,  发布年份 2012

来源: Springer

【 摘 要 】

BackgroundDeceased donor kidneys are a scarce health resource, yet patient preferences for organ allocation are largely unknown. The aim of this study was to determine patient preferences for how kidneys should be allocated for transplantation.MethodsPatients on dialysis and kidney transplant recipients were purposively selected from two centres in Australia to participate in nominal/focus groups in March 2011. Participants identified and ranked criteria they considered important for deceased donor kidney allocation. Transcripts were thematically analysed to identify reasons for their rankings.ResultsFrom six groups involving 37 participants, 23 criteria emerged. Most agreed that matching, wait-list time, medical urgency, likelihood of surviving surgery, age, comorbidities, duration of illness, quality of life, number of organs needed and impact on the recipient's life circumstances were important considerations. Underpinning their rankings were four main themes: enhancing life, medical priority, recipient valuation, and deservingness. These were predominantly expressed as achieving equity for all patients, or priority for specific sub-groups of potential recipients regarded as more "deserving".ConclusionsPatients believed any wait-listed individual who would gain life expectancy and quality of life compared with dialysis should have access to transplantation. Equity of access to transplantation for all patients and justice for those who would look after their transplant were considered important. A utilitarian rationale based on maximizing health gains from the allocation of a scarce resource to avoid "wastage," were rarely expressed. Organ allocation organisations need to seek input from patients who can articulate preferences for allocation and advocate for equity and justice in organ allocation.

【 授权许可】

CC BY   
© Tong et al; licensee BioMed Central Ltd. 2012