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Kidney Week

Abstract: TH-PO1150

Care Practices for Patients with Advanced Kidney Disease Who Were Evaluated for Transplant but Did Not Receive a Kidney

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Butler, Catherine, University of Washington, Seattle, Washington, United States
  • Taylor, Janelle S., University of Washington, Seattle, Washington, United States
  • Reese, Peter P., University of Pennsylvania, Ardmore, Pennsylvania, United States
  • O'Hare, Ann M., VA Puget Sound Health Care System, Seattle, Washington, United States
Background

There is strong public and professional support for increasing access to kidney transplant for patients with advanced kidney disease. However, more liberal referral practices will likely also increase the number of patients who are evaluated for transplant but do not receive a kidney. A deeper understanding of the implications of being referred for transplant evaluation but not receiving a kidney may help to support shared decision-making about transplant referral.

Methods

Qualitative analysis using documentation in the electronic medical record for 148 adults with advanced kidney disease referred to the Veterans Affairs Puget Sound Health Care System’s transplant coordinator from 2008-2018 who did not receive a kidney during the follow-up period (among a total of 209 adults evaluated for kidney transplant). Participants were followed through their date of death or January 1, 2018. We performed an inductive content analysis to ascertain dominant emergent themes related to transplant evaluation.

Results

By the end of follow-up, 148 of 209 patients evaluated for transplant (71%) had not received a kidney. Three dominant themes emerged from analysis of the electronic medical record for this subset of patients: 1) Sources of forward momentum in the transplant evaluation process: Patients were often referred for transplant evaluation reflexively and the process tended to move forward until an absolute contraindication was identified or patients passively disengaged. 2) Potential for transplant shapes other medical decisions: Engagement in the transplant evaluation could have far-reaching effects on many other aspects of patients’ medical care. 3) Personal responsibility and psychological burden: Patients felt personally responsible for their progress through the transplant evaluation and the process could take a significant emotional toll on both patients and families.

Conclusion

Most patients evaluated for transplant at our center did not receive a kidney. The evaluation process could be burdensome and emotionally taxing for these patients and their families and could intrude on many other aspects of their care. These findings highlight the potential tradeoffs involved in being evaluated for kidney transplant and argue for engaging patients in a deliberate and shared approach to referral decisions.

Funding

  • NIDDK Support