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

https://doi.org/10.1053/j.ajkd.2005.07.031Get rights and content

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.

Section snippets

Methods

A questionnaire was constructed with 9 scenarios. In each scenario, the participant was invited to select which 1 of 2 hypothetical patients should receive a deceased donor kidney. Each scenario explored a different aspect of current allocation schemes. Two of the scenarios presented were very similar and were included to test patient understanding of the issues (internal validation). The questionnaire included a 1-page information sheet about deceased donor kidney allocation and was anonymous

Results

Two hundred thirty-two of 295 invited patients (78.6%) completed the questionnaire, consisting of 104 of 153 invited hemodialysis patients (68.0%) and 128 of 142 invited transplant recipients (90.1%). Age and sex distribution and transplant history are listed in Table 2. Average age, sex distribution, and percentage of patients on the transplant waiting list were similar in patients who did not participate (data not shown).

Discussion

The subject of organ allocation has stimulated debate since the early days of renal transplantation. A balance must be struck between optimizing overall graft outcomes (often termed “utility”) and providing patients with a reasonable opportunity for transplantation (often termed “justice”). This debate has been heightened recently with increasing evidence of a significant survival advantage for those who undergo transplantation over wait-listed patients who remain on dialysis therapy.1 It is

References (15)

  • P.J. Morris et al.

    Analysis of factors that affect outcome of primary cadaveric renal transplantation in the UK

    Lancet

    (1999)
  • X. Su et al.

    Diminishing significance of HLA matching in kidney transplantation

    Am J Transplant

    (2004)
  • R.A. Wolfe et al.

    Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant

    N Engl J Med

    (1999)
  • H.U. Meier-Kriesche et al.

    Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomesA paired donor kidney analysis

    Transplantation

    (2002)
  • UK Transplant: Kidney (renal) Organ Allocation. Available at:...
  • UK Transplant: National Kidney Allocation Scheme. Points Scoring. Available at:...
  • United Network for Organ Sharing: OPTN/UNOS Policy 3.5. Organ Distribution: Allocation of Deceased Kidneys. Available...
There are more references available in the full text version of this article.

Cited by (25)

  • Public Perception of Organ Donation and Transplantation Policies in Southern Spain

    2022, Transplantation Proceedings
    Citation Excerpt :

    Another systematic review also encountered a preference for utilitarian criteria among health care professionals, which is not the case among patients, who mostly lean toward urgency [29]. Our study shows that a majority of the public prefers allocating organs based on nonutilitarian criteria, which is consistent with other surveys on allocation conducted over the last 2 decades within diverse segments of the population and in different countries [30,31]. Further research is needed to better understand lay people's preferred moral pathways in organ allocation.

  • Comparing preferences of physicians and patients regarding the allocation of donor organs: A systematic review

    2020, Transplantation Reviews
    Citation Excerpt :

    This general tendency is confirmed by the qualitative studies as well [21,27,30]. The time a candidate for transplantation has been on the waiting list has been evaluated in six different studies [21,24–27,30], whereas especially the quantitative studies show a preference for candidates longer on the waiting list in both physicians and patients [24,26]. The impact of whether the recipient is compliant with pre- and post-transplantation treatment on the allocation decision has been evaluated in six different studies [20–24,30].

  • A new kidney allocation policy in Chile: Computer-based simulations

    2013, Transplantation Proceedings
    Citation Excerpt :

    Additionally pediatric recipients (younger than 18 years) receive extra points. After gathering information on other allocation systems by a literature review,3–10 a new system was initially proposed and a consensus reached among transplantation physicians. The new system is also based on ABO identity, but incorporates several tiers at which kidney offers are made to patients: first, medical priorities, and consecutively to living individuals who had previously acted as kidney donors; 0–HLA mismatched (mm) recipients; and pediatric cases.

  • A Recipient Risk Score for Deceased Donor Renal Allocation

    2007, American Journal of Kidney Diseases
View all citing articles on Scopus

Originally published online as doi:10.1053/j.ajkd.2005.07.031 on October 3, 2005.

C.C.G. conceived the study, designed the questionnaire, designed the study, analyzed the data, and drafted the manuscript; R.S.C.R. had a major role in designing the questionnaire and drafting the manuscript; C.S. had a major role in designing the questionnaire and collecting and analyzing the data; and A.G. had a major role in collecting the data.

View full text