Sancho Carina, Affdal Aliya, Ballesteros Gallego Fabián-Andrés, Malo Marie-Françoise, Cochran-Mavrikakis Savannah-Lou, Cardinal Héloise, Gill John S, Fortin Marie-Chantal
Bioethics Program, École de santé publique de l'Université de Montréal, Québec, Canada.
Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM), Québec, Canada.
Can J Kidney Health Dis. 2024 Jul 30;11:20543581241267165. doi: 10.1177/20543581241267165. eCollection 2024.
There is a gap between the number of patients waiting for a transplant and the number of kidneys available. Some deceased donor kidneys are currently nonutilized, as medical teams fear that they will experience suboptimal graft survival. However, these organs could provide an acceptable therapeutic option if they were allocated for preemptive kidney transplantation in elderly candidates.
This project aims to gather patients' perspectives on the allocation of kidneys with lower longevity for preemptive kidney transplantation in elderly patients.
Individual interviews.
The Center hospitalier de l'Université de Montréal (CHUM) chronic kidney disease (CKD) clinic.
Patients aged between 64 and 75 years with CKD G4-5 ND, followed at the CHUM and who have not initiated dialysis yet.
Between March and July 2023, we conducted 14 individual interviews with patients aged between 64 and 75 years who had CKD G4-5 ND and were followed at the CHUM. The interviews were digitally recorded and transcribed. Thematic analysis was conducted.
Most participants were in favor of using kidneys with lower longevity to increase their access to transplantation, improve their quality of life, enable accelerated transplantation, and avoid dialysis. Patients also wanted to be engaged in the decision-making process, underlining the importance of informed consent. Although the use of kidneys with lower longevity offers the hope of returning to "normal" life, some patients were concerned about the risk of reduced graft survival and the need for a subsequent kidney transplant. In these cases, patients were interested in using mitigation strategies, such as prioritization for kidney transplantation from standard donors in case of early graft loss associated with receiving kidneys with lower longevity. They also recommended the development of a separate waiting list for patients consenting to preemptive transplantation with kidneys with lower longevity.
This study was conducted in only 1 nephrology clinic in the province of Quebec with French-speaking patients. Consequently, the results may not be generalizable to other populations, including ethnic minorities.
The use of kidneys with lower longevity for preemptive kidney transplantation appears to be an interesting option for elderly kidney transplant candidates. However, patient information and participation in the decision-making process are essential. Moreover, organ donation organizations and transplant programs should develop a separate waitlist for transplant candidates who have preconsented to receive organ offers of deceased donor kidneys with lower longevity.
Not registered.
等待移植的患者数量与可用肾脏数量之间存在差距。目前，一些来自已故捐赠者的肾脏未得到利用，因为医疗团队担心这些肾脏的移植存活率不理想。然而，如果将这些器官分配给老年候选者进行抢先肾移植，它们可能会提供一个可接受的治疗选择。
本项目旨在收集患者对于将寿命较短的肾脏用于老年患者抢先肾移植分配的看法。
个人访谈。
蒙特利尔大学中心医院（CHUM）慢性肾脏病（CKD）诊所。
年龄在64至75岁之间、患有CKD G4 - 5 ND、在CHUM接受随访且尚未开始透析的患者。
在2023年3月至7月期间，我们对14名年龄在64至75岁之间、患有CKD G4 - 5 ND且在CHUM接受随访的患者进行了个人访谈。访谈进行了数字录音和转录，并进行了主题分析。
大多数参与者赞成使用寿命较短的肾脏来增加他们获得移植的机会、改善生活质量、实现加速移植并避免透析。患者还希望参与决策过程，强调了知情同意的重要性。尽管使用寿命较短的肾脏有望回归“正常”生活，但一些患者担心移植存活率降低的风险以及后续进行肾移植的必要性。在这些情况下，患者对使用缓解策略感兴趣，例如在因接受寿命较短的肾脏而早期移植失败时，优先从标准捐赠者进行肾移植。他们还建议为同意接受寿命较短的肾脏进行抢先移植的患者设立单独的等候名单。
本研究仅在魁北克省的1家肾脏病诊所对说法语的患者进行。因此，结果可能不适用于其他人群，包括少数族裔。
将寿命较短的肾脏用于抢先肾移植似乎是老年肾移植候选者的一个有趣选择。然而，患者信息和参与决策过程至关重要。此外，器官捐赠组织和移植项目应为预先同意接受寿命较短的已故捐赠者肾脏器官捐赠的移植候选者制定单独的等候名单。
未注册。
