Attitudes among transplant professionals regarding shifting paradigms in eligibility criteria for live kidney donation

Lafranca, Jeffrey A.; Spoon, Emerentia Q. W.; Wetering, Jacqueline van de; IJzermans, Jan N. M.; Dor, Frank J. M. F.

doi:10.1371/journal.pone.0181846

Cited by 22 publications

(19 citation statements)

References 42 publications

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“…Long-term follow-up data, especially for “extended criteria” or “complex” living donors (e.g., donors with obesity, older age, hypertension, vascular multiplicity) are lacking, as these donors have been increasingly accepted, mainly during the last decade. It has been shown that donors with overweight/obesity and donors with vascular multiplicity have good short-term results [ 46 ].…”

Section: Discussionmentioning

confidence: 99%

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The Evolution of Living Donor Nephrectomy Program at A Hellenic Transplant Center. Laparoscopic vs. Open Donor Nephrectomy: Single-Center Experience

Vernadakis

Marinaki

Darema

et al. 2021

JCM

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Since its introduction in 1995, laparoscopic nephrectomy has emerged as the preferred surgical approach for living donor nephrectomy. Given the ubiquity of the surgical procedure and the need for favorable outcomes, as it is an elective operation on otherwise healthy individuals, it is imperative to ensure appropriate preoperative risk stratification and anticipate intraoperative challenges. The aim of the present study was to compare peri-and postoperative outcomes of living kidney donors (LD), who had undergone laparoscopic nephrectomy (LDN), with a control group of those who had undergone open nephrectomy (ODN). Health-related quality of life (QoL) was also assessed using the validated SF-36 questionnaire. Data from 252 LD from a single transplant center from March 2015 to December 2020 were analyzed retrospectively. In total, 117 donors in the LDN and 135 in the ODN groups were assessed. Demographics, type of transplantation, BMI, duration of surgery, length of hospital stay, peri- and postoperative complications, renal function at discharge and QoL were recorded and compared between the two groups using Stata 13.0 software. There was no difference in baseline characteristics, nor in the prevalence of peri-and postoperative complications, with a total complication rate of 16% (mostly minor, Clavien–Dindo grade II) in both groups, while a different pattern of surgical complications was noticed between them. Duration of surgery was significantly longer in the ODN group (median 240 min vs. 160 min in LDN, p < 0.01), warm ischemia time was longer in the LDN group (median 6 min vs.2 min in ODN, p < 0.01) and length of hospital stay shorter in the LDN group (median 3 days vs. 7 days in ODN). Conversion rate from laparoscopic to open surgery was 2.5%. There was a drop in estimated glomerular filtration rate (eGFR) at discharge of 36 mL/min in the LDN and 32 mL/min in the ODN groups, respectively (p = 0.03). No death, readmission or reoperation were recorded. There was a significant difference in favor of LDN group for each one of the eight items of the questionnaire (SF1–SF8). As for the two summary scores, while the total physical component summary (PCS) score was comparable between the two groups (57.87 in the LDN group and 57.07 in the ODN group), the mental component summary (MCS) score was significantly higher (62.14 vs. 45.22, p < 0.001) in the LDN group. This study provides evidence that minimally invasive surgery can be performed safely, with very good short-term outcomes, providing several benefits for the living kidney donor, thereby contributing to expanding the living donor pool, which is essential, especially in countries with deceased-donor organ shortage.

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Section: Discussionmentioning

confidence: 99%

“…In the USA, there seems to be a stricter policy regarding donor age. On the other hand, British guidelines state that older age represents, not an absolute contra-indication for donation, but that the medical work up of these donors should be particularly rigorous to ensure suitability [ 34 , 46 ].…”

Section: Discussionmentioning

confidence: 99%

The Evolution of Living Donor Nephrectomy Program at A Hellenic Transplant Center. Laparoscopic vs. Open Donor Nephrectomy: Single-Center Experience

Vernadakis

Marinaki

Darema

et al. 2021

JCM

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“…Standardizing the referral process is a bit challenging as there is considerable amount of heterogeneity in the ideologies and preferences of centers and physicians. 42,79,80 It is known that even when policies are created, transplant professionals will deviate. 79 However, some level of standardization should be implemented to guide referring centers.…”

Section: Discussionmentioning

confidence: 99%

Health Professional–Identified Barriers to Living Donor Kidney Transplantation: A Qualitative Study

Sandal

Charlebois²,

Fiore

et al. 2019

Can J Kidney Health Dis

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Background:Living donor kidney transplantation (LDKT) has several advantages over deceased donor kidney transplantation. Yet rates of living donation are declining in Canada and there exists significant interprovincial variability. Efforts to improve living donation tend to focus on the patient and barriers identified at their level, such as not knowing how to ask for a kidney or lack of education. These efforts favor those who have the means and the support to find living donors. Thus, a Canadian Institutes of Health Research (CIHR)-organized workshop recommended that education efforts to understand and remove barriers should focus on health professionals (HPs). Despite this, little attention has been paid to what they identify as barriers to discussing LDKT with their patients.Objective:Our aim was to explore HP-identified barriers to discuss living donation with patients in 3 provinces of Canada with low (Quebec), moderate (Ontario), and high (British Columbia) rates of LDKT.Design:This study consists of an interpretive descriptive approach as it enables to move beyond description and inform clinical practice.Setting:Purposive criterion and quota sampling were used to recruit HPs from Quebec, Ontario, and British Columbia who are involved in the care of patients with kidney disease and/or with transplant coordination.Patients:Not applicable.Measurements:Semistructured interviews were conducted. The interview guide was developed based on a preliminary analytical framework and a review of the literature.Methods:Thematic analysis was used to analyze the data stemming from the interviews. The coding process comprised of a deductive and inductive approach, and the use of a qualitative analysis software (NVivo 11). Following this, themes were identified and developed. Interviews were conducted until thematic saturation was obtained. In total, we conducted 16 telephone interviews as thematic saturation was attained.Results:Six predominant themes emerged: (1) lack of communication between transplant and dialysis teams, (2) absence of referral guidelines, (3) role perception and lack of multidisciplinary involvement, (4) HP’s lack of information and training, (5) negative attitudes of some HP toward LDKT, (6) patient-level barriers as defined by the HP. HPs did mention patients’ attitudes and some characteristics as the main barriers to discussions about living donation; this was noted in all provinces. HPs from Ontario and British Columbia indicated multiple strategies being implemented to address some of these barriers. Those from Ontario mentioned strategies that center on the core principles of provincial-level standardization, while those from British Columbia center on engaging the entire multidisciplinary team and improved role perception. We noted a dearth of such efforts in Quebec; however, efforts around education and promotion, while tentative, have emerged.Limitations:Social desirability and selection bias. Our analysis might not be applicable to other provinces.Conclusions:HPs involved with the referral and...

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“…To better understand center policies as well as opinions and attitudes of transplant professionals on this topic, Lafranca et al [29] performed an online survey amongst European Society of Transplantation's members (mainly physicians) to reveal potential differences between center criteria and personal opinions regarding eligibility criteria of living kidney donors, both across continents and within European centers. The online survey was sent to 1,128 European Society of Transplantation-members and questionnaires were completed by 331 professionals (including, among others, 117 nephrologists and 182 surgeons) from 55 countries.…”

Section: The Reality Of Living Kidney Donation Eligibilitymentioning

confidence: 99%

Criteria for Living Donation from Marginal Donors: One, No One, and One Hundred Thousand

Cantarelli¹,

Cravedi²

2019

Nephron

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Context: The increasing need for kidney grafts has led to a progressive expansion in the selection criteria for deceased and living donors (LDs). While concerns regarding the use of organs from suboptimal deceased donors relate to the quality of the graft, donation from “marginal” LDs may pose potential harm to the donor. Subject of Review: Living kidney donation is a safe procedure, but is associated with a small risk of end-stage kidney disease in the long- term. When elderly subjects and those with comorbidities are considered, long-term post-donation data are missing, making decisions regarding donation from these populations challenging. Further, vague guidelines have led to a wide heterogeneity in the criteria for living donation from marginal donors across centers and individuals. A recent survey by Lafranca et al. [PLoS One 2017;12:e0181846] collected information from 331 members (mainly physicians) of the European Society of Transplantation regarding several expanded LD criteria. Median refusal rate for potential expanded criteria (ECD) LDs is 15% and the authors found significant differences across regions in Europe in the acceptance of donors with ECD. Some transplant specialists did also deviate from their own transplant center policy, mainly to consider donors with high body mass index. Second Opinion: The survey by Lafranca et al. [PLoS One 2017;12:e0181846] documents extreme variability in the criteria for marginal LD selection. Many centers are deviating from the few agreed upon guideline criteria and are considering individuals with hypertension and minors for kidney donation. Intriguingly, one-fourth of the surgeons even deviate occasionally from center policy, especially when the issue is donor obesity. By and large, these data indicate that transplant community has a generally open approach toward extension of criteria for living donation, but long-term follow-up studies are needed to draw solid conclusions and guidelines.

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Attitudes among transplant professionals regarding shifting paradigms in eligibility criteria for live kidney donation

Cited by 22 publications

References 42 publications

The Evolution of Living Donor Nephrectomy Program at A Hellenic Transplant Center. Laparoscopic vs. Open Donor Nephrectomy: Single-Center Experience

The Evolution of Living Donor Nephrectomy Program at A Hellenic Transplant Center. Laparoscopic vs. Open Donor Nephrectomy: Single-Center Experience

Health Professional–Identified Barriers to Living Donor Kidney Transplantation: A Qualitative Study

Criteria for Living Donation from Marginal Donors: One, No One, and One Hundred Thousand

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