Kidney Transplantation: Patient Preference Should be Considered During Allocation

Patient preferences are generally ignored in the kidney allocation algorithm. A systematic and standardized patients’ preference could be a useful tool to improve welfare in organ allocation programs.

Including patients' preferences while allocating kidneys for transplant would considerably improve both their satisfaction and the expected graft survival. Patients should be allowed to review their preferences at regular frequencies. This will help patients better understand their treatment options and outcomes. A patients’ willingness to wait depends on their age and duration of dialysis treatment.

From the moment a kidney becomes available, there are just 24 hours to identify the recipient and carry out the transplant. Waiting lists are extremely long, available organs are few and not all of them are 'ideal'. Furthermore, a recipient has the ability to 'refuse' a kidney, for instance by continuing with the dialysis treatment while waiting for a better moment, thus complicating the race against time to carry out the transplant.

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‘Patients who are not willing to take any risk might want to wait longer to get the right kidney. Patients who find the dialysis treatment unbearable, could be willing to take an augmented risk kidney, so they can get the transplant as soon as possible’
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This issue involving the scarcity of resources and an array of delicate choices, could be resolved in a more efficient manner if the allocation system accounted for the patients' preferences, alongside parameters of compatibility, age and waiting time.

These are the results of a study recently published in the Journal of Health Economics by Giacomo Pasini, professor of Economics at Ca' Foscari University of Venice, co-authored by Mesfin G. Genie - who received its PhD in Economics at Ca' Foscari and is now working at the University of Aberdeen - and Antonio Nicolò of the University of Padua. The field work was made possible thanks to a strategic project fund granted by the University of Padua.

The economists interviewed 248 patients on the waiting list for a kidney transplant at the Kidney and Pancreas Transplantation Unit of the University of Padua's School of Medicine, one of the key centres in Italy, with over 2000 operations completed.

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The experiment allowed the researchers to analyze the patients' preferences regarding different variables such as waiting time, post-graft life expectancy, infection risk and the neoplastic risk.

Patients who are not willing to take any risks, for example, might want to wait longer to get the 'perfect' kidney. Conversely, patients who find the dialysis treatment particularly unbearable, such as parents of young children whose life quality is seriously hindered by the number of hours they need to spend in the hospital, could be willing to accept an augmented risk kidney, just so they can get the transplant as soon as possible.

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"We found a significant heterogeneity in the preferences of patients who are waiting for a transplant - explains Giacomo Pasini - Furthermore, we have proved how including patients' preferences in the kidney allocation algorithm would considerably improve both the patients' satisfaction and the expected graft survival."

The study has also tackled the internationally relevant topic of the so-called "marginal" kidney - that is to say potentially suitable kidneys, but inferior to standard criteria.

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Examples are: kidneys from deceased older donors or those of a young person who died in a car crash, as a residual infection risk cannot be excluded.

"Marginal kidneys are currently offered only to those patients who have been on the waiting list for a long time - stated Professor Pasini - our article suggests there might be more patients who are willing to accept a marginal kidney right away. Broadly speaking, we are putting forward a way to improve the kidney allocation system that could improve both the efficiency of the procedure (an increase in the number of transplants completed) and the life quality of the patients".

Source-Eurekalert