Summary 2: Patient and Provider Attitudes Toward Patient-Facing Kidney Organ Offer Reporting
This study by Husain et al. highlights an important issue that causes tension in the field of transplantation: The balance between efficiency and transparency. Transplant centers routinely decline deceased donor kidney offers on behalf of candidates and most patients remain unaware of these important decisions. In this national survey from the United Stated nearly two- thirds of patients believed that transplant programs should be required to disclose information regarding declined organ offers. In contrast, most surgical and medical directors from kidney transplant programs opposed such disclosure.
These findings underscore an important reality: Patients and transplant professionals may have different expectations regarding participation in organ offer decision-making. Transplant systems are increasingly favoring patient-centered care and having greater transparency regarding organ offers may represent the next step in advancing shared decision-making.
Although organ allocation systems vary considerably across the world and the relevance of these findings well beyond the United States. In most countries complex allocation systems rely on clinicians to apply their clinical judgment when making organ acceptance decisions with little or no direct patient involvement. Balancing efficiency, organ utilization and patient autonomy remains a challenge that transplant programs globally must address.
Furthermore, changing the practices of entire transplant systems is challenging, and transparency alone is unlikely to improve outcomes. Information regarding organ offers may be overwhelming for some patients and it might be difficult to interpret without appropriate clinical context. Organ quality discussions and the rationale for declining an offer requires involvement of transplant professionals. Transplant programs are expected to discuss information that most patients consider important, including donor age, organ quality, KDPI (Kidney donor profile index), infectious risk, history of malignancy and alternative options such as waiting for a future offer. At the same time, withholding information risks undermining trust and may limit opportunities to better understand individual preferences. This study suggests that patients often prioritize these trade offs very differently from clinicians.
Most patients expressed more transparency regarding declined organ offers and believe that transplant centers should be required to disclose this information. Rather than involving patients in real-time organ offers, a more practical approach may involve structured reporting of declined offers after the fact, coupled with ongoing discussions regarding patients’ preferences and acceptable risk thresholds. Such an approach could strengthen patient engagement and shared decision-making while preserving the time-sensitive nature of organ allocation
Summary 1: The Potential of Kidney Transplantation to Reduce Mortality from Chronic Kidney Disease: a Global, Cross-Sectional, Modelling Study
Summary:
Across 203 countries and territories with data from the GBD and ISN-GKHA, the median age-standardised prevalence of chronic kidney disease (CKD) was 7.78% (IQR 6.54–9.48%). Data availability increased with national income (p<0.0001). Higher GDP per capita (GDP-PC) was associated with higher rates of kidney replacement therapy (KRT)—including both dialysis and kidney transplantation (p<0.0001)—and with a lower mortality–prevalence ratio (MPR; p<0.0001). In multivariable analysis, reductions in MPR were independently associated with GDP-PC (coefficient –0.258; 95% CI –0.413 to –0.103; p=0.0031) and kidney transplantation rates (–574; –1090 to –43.5; p=0.039), but not dialysis rates (p=0.22). Conservative increases in transplantation rates were estimated to avert approximately 290,000 CKD-related deaths annually.
Comment:
This global ecological analysis demonstrates that although national wealth is strongly linked to greater access to KRT and improved CKD outcomes, kidney transplantation, rather than dialysis alone, emerged as the KRT modality most strongly associated with improved population-level CKD outcomes. Higher transplantation rates were independently associated with lower MPR and fewer disability-adjusted life-years (DALYs), whereas dialysis showed no independent benefit after adjustment.
These findings suggest that expanding dialysis without a parallel investment in transplantation may be insufficient to improve outcomes. Notably, even modest increases in transplantation rates were associated with substantial gains, with modelling indicating the potential to avert hundreds of thousands to over one million deaths annually and reduce millions of DALYs worldwide. Together, these results position transplantation access as a critical determinant of global CKD survival and support prioritising transplant-centred strategies within national and international health policy frameworks.
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