School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada.
Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada.
BMC Nephrol. 2023 Jun 9;24(1):165. doi: 10.1186/s12882-023-03224-z.
The widening supply-demand imbalance for kidneys necessitates finding ways to reduce rejection and improve transplant outcomes. Human leukocyte antigen (HLA) epitope compatibility between donor and recipient may minimize premature graft loss and prolong survival, but incorporating this strategy to deceased donor allocation criteria prioritizes transplant outcomes over wait times. An online public deliberation was held to identify acceptable trade-offs when implementing epitope compatibility to guide Canadian policymakers and health professionals in deciding how best to allocate kidneys fairly.
Invitations were mailed to 35,000 randomly-selected Canadian households, with over-sampling of rural/remote locations. Participants were selected for socio-demographic diversity and geographic representation. Five two-hour online sessions were held from November-December 2021. Participants received an information booklet and heard from expert speakers prior to deliberating on how to fairly implement epitope compatibility for transplant candidates and governance issues. Participants collectively generated and voted on recommendations. In the final session, kidney donation and allocation policymakers engaged with participants. Sessions were recorded and transcribed.
Thirty-two individuals participated and generated nine recommendations. There was consensus on adding epitope compatibility to the existing deceased donor kidney allocation criteria. However, participants recommended including safeguards/flexibility around this (e.g., mitigating declining health). They called for a transition period to epitope compatibility, including an ongoing comprehensive public education program. Participants unanimously recommended regular monitoring and public sharing of epitope-based transplant outcomes.
Participants supported adding epitope compatibility to kidney allocation criteria, but advised safeguards and flexibility around implementation. These recommendations provide guidance to policymakers about incorporating epitope-based deceased donor allocation criteria.
肾脏供需失衡加剧，因此需要寻找减少排斥反应、改善移植效果的方法。供体和受体之间人类白细胞抗原（HLA）表位的兼容性可以最大限度地减少移植物的早期丢失并延长存活时间，但将这一策略纳入到已故供体分配标准中，优先考虑移植效果而不是等待时间。我们进行了一次在线公众审议，以确定在实施表位兼容性时可以接受的权衡，从而为加拿大政策制定者和卫生专业人员提供指导，帮助他们决定如何公平地分配肾脏。
向 35000 名随机选择的加拿大家庭邮寄了邀请函，并对农村/偏远地区进行了超额抽样。参与者是根据社会人口统计学的多样性和地域代表性选择的。2021 年 11 月至 12 月期间举行了五次为期两小时的在线会议。在审议如何公平地为移植候选人实施表位兼容性和管理问题之前，参与者收到了一本信息手册并听取了专家的演讲。参与者共同提出并投票表决建议。在最后一次会议上，肾脏捐赠和分配政策制定者与参与者进行了互动。会议进行了录制和转录。
32 人参与并提出了 9 项建议。他们一致认为应将表位兼容性添加到现有的已故供体肾脏分配标准中。然而，参与者建议围绕这一标准纳入保障措施/灵活性（例如，减轻健康状况的恶化）。他们呼吁逐步过渡到表位兼容性，并包括一个持续的全面公众教育计划。参与者一致建议定期监测和公开分享基于表位的移植结果。
参与者支持将表位兼容性添加到肾脏分配标准中，但建议在实施过程中提供保障措施和灵活性。这些建议为政策制定者提供了有关纳入基于表位的已故供体分配标准的指导。
