Recipient Management

Tuesday July 03, 2018 from 16:30 to 17:30

Room: Hall 10 - Exhibition

C490.2 Differing opinions regarding diseased kidney allocation between patients and physicians and also among physician’s specialties

Javier Dominguez, Chile

Departamento de Urologia
Pontificia Universidad Católica de Chile

Abstract

Differing Opinions Regarding Diseased Kidney Allocation between Patients and Physicians and also among Physician’s Specialties

Javier Dominguez1, Paula Bedegral2, Martin Aburto1, Hector Gallegos1, Alejandro Rojas1.

1Departamento de Urologia Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; 2Departamento de Salud Publica Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

Kidney allocation should try to find the correct balance between equity and efficiency. Rarely patients’ opinions have been included in the process of establishing or changing policies regarding kidney allocation. Furthermore potential differences among physicians’ opinions have not been studied. The aim of this work is to report the findings of a survey applied to physicians and patients regarding kidney allocation policies.
Methods: A 17 question, semi quantitative (Likert scale) survey was developed including current and new criteria for kidney allocation. At the end of the survey participants were asked to assign a percentage to 3 of the most used criteria for allocation; HLA compatibility (HLAC), time on the waiting list (TWL) and age (for non pediatric recipients). 119 patients (59 with a functioning kidney and 61 on the waiting list) and 83 physicians (53 Nephrologists and 30 transplant surgeons) were surveyed. The same survey was applied to both patients and physicians. The survey was validated on a small number of physicians and patients and modifications were made to improve understanding. Prior to taking the survey the current rule for allocating kidneys was briefly described.  Likert scale was converted to numerical values for comparisons using non parametric statistics.
Results:Patients were more prone to accept a preponderance of HLAC over TWL than doctors (p<0,01), but were more in favor of calculating TWL since the beginning of dialysis than Physicians (p<0,05). Doctors considered that extra scores for pediatric patients was more important and were more reluctant to punish noncompliance for a second transplant than patients (p<0,05). Patients strongly agreed on having their opinion considered when generating allocation systems (p<0.001). When assigning percentage to different factors, patients again gave more importance to HLAC (51% vs 45% p<0,05) than TWL (27% vs. 33% p <0,01).  When comparing physicians specialties Transplant surgeons are more prone to favor TWL vs HLAC than Nephrologists and less inclined to favor pediatric recipients with extra score (p<0,05).
Conclusions: Patients and physicians’ opinions differ significantly on allocation rules.  It seems that doctors are more concerned on equity issues such as the importance of TWL over HLAC. On the other hand patients are more in favor of punishing non compliant patients than doctors.  Moreover there are different perceptions between physicians’ specialties.  These differences have to be taken into account when creating and changing allocation rules.

Financiado por proyecto puente VRI PUC N 31/2015.



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