Influential Factors in Kidney Transplant Include Social Support, Life Expectancy

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The most influential factors associated with transplant decision making included the patient’s life expectancy with transplant, therapy adherence, and social support.
The most influential factors associated with transplant decision making included the patient’s life expectancy with transplant, therapy adherence, and social support.

According to a study published in the Journal of Medical Ethics, transplant providers are more likely to choose candidates for kidney transplant if the person has a strong social support network. Findings indicate that many clinicians view social support in particular as a key factor in choosing a candidate for transplant.

In 2016, researchers performed a survey among providers in the American Society of Transplant Surgeons and Society for Transplant Social Work regarding listing decisions and candidate evaluations for kidney transplant (n=584). Survey respondents compared 2 example patient profiles and were asked to select which patient was more appropriate for transplantation.

Factors evaluated in each patient profile included age, life expectancy with and without transplant, quality of life with transplant, social support status, adherence with therapy, and time spent waiting for transplant. Following the survey, investigators sought to determine which factors were associated with an increased likelihood of choosing a patient for transplant.

The most influential factors associated with transplant decision making included the patient's life expectancy with transplant, therapy adherence, and social support. Respondents were 1.68 times more likely to choose transplant for a patient with social support (95% CI, 1.50-1.86; P <.001). Additionally, respondents were 1.64 times more likely to select a patient for transplant who adhered with therapy (95% CI, 1.46-1.88; P <.001) and 1.61 times more likely to choose a patient with a 15-year life expectancy following transplant (95% CI, 1.42-1.85; P <.001).

The study is limited in the number of nephrologists included in the American Society of Transplant Surgeons as well as the lack of data on patients' perspectives regarding transplant and social support.

According to the researchers, “[T]he transplant community should re-examine use of social support in patient evaluation and improve definitions and assessments to ensure transparency and equity in access to transplantation.”

Reference

Ladin K, Emerson J, Butt Z, et al. How important is social support in determining patients' suitability for transplantation? Results from a National Survey of Transplant Clinicians [published online June 28, 2018]. J Med Ethics. doi:10.1136/medethics-2017-104695.

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