1 Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. 2 Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia. 3 Centre for Transplant and Renal Research, Westmead Hospital, NSW, Westmead, Australia. 4 Department of Nephrology, Charité-Universitätsmedizin, Berlin, Germany. 5 Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Berlin, Germany. 6 Address correspondence to: Allison Tong, Ph.D., Centre for Kidney Research, The Children's Hospital at Westmead, Westmead NSW 2145, Australia.
Transplantation. 2014 Oct 15;98(7):682-91. doi: 10.1097/TP.0000000000000336.
We aimed to describe nephrologists' attitudes to patients' access to kidney transplantation. Studies that assessed nephrologists' perspectives toward patient referral, screening, and eligibility for kidney transplantation were synthesized. Twenty-four studies (n≥4695) were included. Patients with comorbidities, were nonadherent, of older age, ethnic minorities, or low socioeconomic status were less likely to be recommended. Six themes underpinned nephrologists' perspectives: prioritizing individual benefit and safety, maximizing efficiency, patient accountability, justifying gains, protecting unit outcomes, and reluctance to raise patients' expectations. Evidence-based guidelines may support systematic and equitable decision-making. Interventions for high-risk or disadvantaged patient populations could reduce disparities in access to transplantation.
我们旨在描述肾病学家对患者接受肾移植机会的态度。综合评估了肾病学家对患者转介、筛选和肾移植资格的看法的研究。共纳入 24 项研究（n≥4695）。患有合并症、不依从、年龄较大、少数民族或社会经济地位较低的患者，被推荐的可能性较小。六个主题体现了肾病学家的观点：优先考虑个人利益和安全、最大化效率、患者责任、证明收益、保护单位成果以及不愿提高患者的期望。循证指南可能支持系统和公平的决策制定。针对高风险或弱势群体的干预措施可以减少移植机会的差异。
