Approximately 20% of deceased donor kidneys are discarded every year in the usa, but a recently available study in CJASN indicates that lots of patients on the transplant waitlist would like accepting such lower quality kidneys in substitution for a shorter waiting time.
For the analysis, Sanjay Mehrotra, Ph.D. (Northwestern University) and his colleagues conducted a choice-based experiment that presented the choice of deceased donor kidneys to 605 patients who have been looking forward to or had received a kidney transplant. The options involved tradeoffs between accepting a kidney today or perhaps a future kidney.
The common respondent would accept a kidney today with 6.5 years of expected survival of the transplanted organ in order to avoid waiting 2 additional years for a kidney with 11 years of expected survival.
Three patient-preference classes were identified. Class 1 was averse to additional waiting time but nonetheless attentive to improvements in kidney quality. Class 2 was less ready to accept increases in waiting time for improvements in kidney quality. Class 3 was ready to accept increases in waiting time even for small improvements in kidney quality.
In accordance with class 1, respondents in class 3 were apt to be age 61 or younger also to be waitlisted prior to starting dialysis, and respondents in class 2 were more prone to be older, Black, not need a degree and also have greater functional impairment.
“With an increase of than 90,000 patients looking forward to a kidney transplant, and much more than 15,000 deaths or waitlist removals every year, we have a significant possibility to save lives and dialysis costs, while improving patient standard of living. Our study provides national evidence on patients’ willingness to simply accept marginal kidneys, which is thrown away due to policy and operational inefficiencies in the national transplant system,” said Dr. Mehrotra.
An accompanying editorial notes that the best predictor for improved survival for folks with kidney failure is whether they get a transplant at all. “This study clearly demonstrates a thing that most of us knowthat considering waitlisted patients as a monolithic group that views the tradeoff between waiting time and organ quality similarly is really a mistake,” the authors wrote.
An accompanying Patient Voice article supplies the perspectives of a lifelong kidney patient and three-time kidney transplant recipient. The writer notes that “the analysis can serve as a car to discuss essential innovation in developing a more transparent and patient choicedriven organ allocation system.”
More info: Sanjay Mehrotra et al, Patient Preferences for Waiting Time and Kidney Quality, Clinical Journal of the American Society of Nephrology (2022). DOI: 10.2215/CJN.01480222
Sumit Mohan et al, Improving the use of Deceased Donor Kidneys by Prioritizing Patient Preferences, Clinical Journal of the American Society of Nephrology (2022). DOI: 10.2215/CJN.08500722
Michael “Jack” Lennon, Obtaining a Kidney: Where Is Patient Choice?, Clinical Journal of the American Society of Nephrology (2022). DOI: 10.2215/CJN.08400722
Citation: Transplant candidates’ thoughts about tradeoffs of shorter wait time for lower quality kidneys (2022, August 20) retrieved 20 August 2022 from https://medicalxpress.com/news/2022-08-transplant-candidates-thoughts-tradeoffs-shorter.html
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