Abstract
BackgroundDetermining eligibility for a kidney transplant is one of the most important decisions facing nephrologists. It is assumed that the harm of kidney transplantation is minimal and most will benefit. The purpose of this study was to quantify the probability of ‘no benefit’ as defined by death on the wait list; ‘harm’, defined by the probability that a transplanted patient would live less than the average wait listed patient; and ‘benefit’ for the probability a transplanted patient would outlive the average wait listed patient.MethodsA computerized model was developed to replicate observed patient survival outcomes in deceased donor kidney transplantation. Three sequential periods of risk for the transplanted recipient compared to the wait listed cohort (increased, equivalent and reduced risk) were modeled.ResultsThe model predicted that wait listed patients with a baseline mortality of 28 deaths per 100 patient years were equally likely to benefit or be harmed with a transplant. However if 20% of patients on the wait list were on hold (assuming a 2.2-fold higher mortality than those who were transplanted), then the baseline mortality rate for equal harm or benefit decreases to 22 deaths per 100 patient years (equivalent life expectancy 4.5 years).ConclusionPatients with limited life expectancies are more likely to suffer some harm than derive benefit from kidney transplantation.
Highlights
Determining eligibility for a kidney transplant is one of the most important decisions facing nephrologists
Assuming a mortality rate of 35 deaths per 100 patient years, transplantation is slightly more likely to harm (29%) than benefit (21%), whereas the remaining 50% of the patients are predicted to die on the wait list
Assuming that 20% of patients are inactive on the wait list with a 2.2-fold higher mortality rate, those that are transplanted have lower baseline mortality rates than the entire wait list reference cohort
Summary
Determining eligibility for a kidney transplant is one of the most important decisions facing nephrologists. It is assumed that the harm of kidney transplantation is minimal and most will benefit. Much has been written about the principles of allocating deceased kidney organs to those on the wait list. Less has been written about ethical principles of wait list eligibility. There are several principles that seem reasonable, namely, exclusion of patients who do not want a transplant (autonomy), exclusion of patients where the operation or immunosuppression are likely to cause greater harm (non-maleficence), and exclusion of patients not likely to benefit in deference to those who are likely to benefit (utilitarianism). Some suggest that patients with a life expectancy of less than five years should not be considered for transplantation as they are not likely to derive significant benefit [1]. Some would argue that anyone who might benefit regardless of the risk should have equal access to
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
