Vinson A J, Cardinal H, Parsons C, Tennankore K K, Mainra R, Maru K, Treleaven D, Gill J
Nova Scotia Health Authority, Halifax, Canada.
Division of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, Canada.
Can J Kidney Health Dis. 2023 Feb 23;10:20543581231156855. doi: 10.1177/20543581231156855. eCollection 2023.
Significant variability in organ acceptance thresholds have been demonstrated across the United States, but data regarding the rate and rationale for kidney donor organ decline in Canada are lacking.
To examine decision making regarding deceased kidney donor acceptance and non-acceptance in a population of Canadian transplant professionals.
A survey study of theoretical deceased donor kidney cases of increasing complexity.
Canadian transplant nephrologists, urologists, and surgeons making donor call decisions responding to an electronic survey between July 22 and October 4, 2022.
Invitations to participate were distributed to 179 Canadian transplant nephrologists, surgeons, and urologists through e-mail. Participants were identified by contacting each transplant program and requesting a list of physicians who take donor call.
Survey respondents were asked whether they would accept or decline a given donor, assuming there was a suitable recipient. They were also asked to cite reasons for donor non-acceptance.
Donor scenario-specific acceptance rates (total acceptance divided by total number of respondents for a given scenario and overall) and reasons for decline were determined and presented as a percentage of the total cases declined.
In all, 72 respondents from 7 provinces completed at least one question of the survey, with considerable variability between acceptance rates for centers; the most conservative center declined 60.9% of donor cases, whereas the most aggressive center declined only 28.1%, -value < .001. There was an increased risk of non-acceptance with advancing age, donation after cardiac death, acute kidney injury, chronic kidney disease, and comorbidities.
As with any survey, there is the potential for participation bias. In addition, this study examines donor characteristics in isolation, however, asks respondent to assume there is a suitable candidate available. In reality, whenever donor quality is considered, it should be considered in the context of the intended recipient.
In a survey of increasingly medically complex deceased kidney donor cases, there was significant variability in donor decline among Canadian transplant specialists. Given relatively high rates of donor decline and apparent heterogeneity in acceptance decisions, Canadian transplant specialists may benefit from additional education regarding the benefits achieved from even medically complex kidney donors for appropriate candidates relative to remaining on dialysis on the transplant waitlist.
美国各地已证实器官接受阈值存在显著差异，但加拿大缺乏有关肾脏供体器官拒绝率及理由的数据。
研究加拿大移植专业人员群体中关于已故肾脏供体接受与不接受的决策情况。
对理论上复杂性不断增加的已故供体肾脏病例进行的调查研究。
2022年7月22日至10月4日期间，对做出供体呼叫决策的加拿大移植肾病学家、泌尿科医生和外科医生进行电子调查。
通过电子邮件向179名加拿大移植肾病学家、外科医生和泌尿科医生分发参与邀请。通过联系每个移植项目并索要接听供体呼叫的医生名单来确定参与者。
假设存在合适的受者，调查受访者是否会接受或拒绝给定的供体。还要求他们列举不接受供体的理由。
确定特定供体情况的接受率（给定情况及总体中接受总数除以受访者总数）以及拒绝理由，并以拒绝的总病例数的百分比表示。
共有来自7个省份的72名受访者完成了调查的至少一个问题，各中心的接受率差异很大；最保守的中心拒绝了60.9%的供体病例，而最积极的中心仅拒绝了28.1%，P值<0.001。随着年龄增长、心脏死亡后捐献、急性肾损伤、慢性肾病和合并症，不接受的风险增加。
与任何调查一样，存在参与偏差的可能性。此外，本研究孤立地考察供体特征，但要求受访者假设存在合适的候选人。实际上，在考虑供体质量时，应结合预期受者的情况来考虑。
在一项对医学复杂性日益增加的已故肾脏供体病例的调查中，加拿大移植专家在供体拒绝方面存在显著差异。鉴于相对较高的供体拒绝率和接受决策中明显的异质性，加拿大移植专家可能会从额外的教育中受益，了解对于合适的候选人而言，即使是医学复杂性较高的肾脏供体相对于留在移植等待名单上进行透析所带来的益处。
