Hanson Camilla S, Chadban Steven J, Chapman Jeremy R, Craig Jonathan C, Wong Germaine, Tong Allison
1 Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia. 2 Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia. 3 Department of Renal Medicine, Royal Prince Alfred Hospital, The University of Sydney, Sydney, NSW, Australia. 4 Centre for Transplant and Renal Research, Westmead Hospital, NSW, Westmead, Australia.
Transplantation. 2016 Apr;100(4):943-53. doi: 10.1097/TP.0000000000000921.
Wide variations in access to living kidney donation are apparent across transplant centers. Such disparities may be in part explained by nephrologists' beliefs and decisions about recipient eligibility. This study aims to describe nephrologists' attitudes towards recipient eligibility and access to living kidney donor transplantation.
Face-to-face semistructured interviews were conducted from June to October 2013 with 41 nephrologists from Australia and New Zealand. Transcripts were analyzed thematically.
We identified five major themes: championing optimal recipient outcomes (maximizing recipient survival, increasing opportunity, accepting justified risks, needing control and certainty of outcomes, safeguarding psychological wellbeing), justifying donor sacrifice (confidence in reasonable utility, sparing the donor, ensuring reciprocal donor benefit), advocating for patients (being proactive and encouraging, addressing ambivalence, depending on supportive infrastructure, avoiding selective recommendations), maintaining professional boundaries (minimizing conflict of interest, respecting shared decision-making, emphasizing patient accountability, restricted decisional power, protecting unit interests), and entrenched inequities (exclusivity of living donors, inherently advantaging self-advocates, navigating language barriers, increasing center transparency, inevitable geographical disadvantage, understanding cultural barriers).
Nephrologists' decisions about recipient suitability for living donor transplantation aimed to achieve optimal recipient outcomes, but were constrained by competing priorities to ensure reasonable utility derived from the donor kidney and protect the integrity of the transplant program. Comprehensive guidelines that provide explicit recommendations for complex medical and psychosocial risk factors might promote more equitable and transparent decision-making. Psychosocial support and culturally sensitive educational resources are needed to help nephrologists advocate for disadvantaged patients and address disparities in access to living kidney donor transplantation.
各移植中心在活体肾移植的可及性方面存在明显差异。这种差异部分可能是由肾病学家对受者资格的看法和决定所导致的。本研究旨在描述肾病学家对受者资格以及活体肾移植可及性的态度。
2013年6月至10月，对来自澳大利亚和新西兰的41位肾病学家进行了面对面的半结构化访谈。对访谈记录进行了主题分析。
我们确定了五个主要主题：支持最佳受者结局（最大化受者生存率、增加机会、接受合理风险、需要结局的可控性和确定性、保障心理健康），为供者的牺牲辩护（对合理效用有信心、使供者免受伤害、确保供者获得相应益处），为患者代言（积极主动并给予鼓励、解决矛盾心理、依赖支持性基础设施、避免选择性推荐），维持专业界限（最小化利益冲突、尊重共同决策、强调患者责任、限制决策权、保护单位利益），以及根深蒂固的不平等（活体供者的排他性、天生有利于自我倡导者、应对语言障碍、提高中心透明度、不可避免的地理劣势、理解文化障碍）。
肾病学家关于受者是否适合活体供者移植的决定旨在实现最佳受者结局，但受到相互竞争的优先事项的限制，以确保从供肾中获得合理效用并保护移植项目的完整性。针对复杂的医学和心理社会风险因素提供明确建议的综合指南可能会促进更公平和透明的决策。需要心理社会支持和具有文化敏感性的教育资源，以帮助肾病学家为弱势患者代言，并解决活体肾移植可及性方面的差异。
