Transplant Professionals’ Perceptions of Long-Term Care Residents’ Candidacy for Kidney Transplantation

Abstract

Context:

Given the aging end-stage renal disease (ESRD) population, kidney transplant (KTx) centers may experience an increase in referrals of patients living in long-term care (LTC) settings (eg, skilled nursing facilities, assisted living facilities, group homes, and boarding homes).

Objective:

To identify best practices among KTx professionals when considering individuals in LTC settings for transplantation.

Design and Setting:

A cross-sectional survey administered online to US transplant professionals via e-mail LISTSERVs and other professional networks.

Participants:

One hundred twenty-six KTx professionals working in the United States.

Main Outcome Measures:

The survey was composed of demographic questions and 6 hypothetical scenarios. These scenarios asked participants to assess transplant candidacy of patients with ESRD living in LTC settings based on the information provided in the scenario. Each scenario presented a different variable that necessitated LTC placement, including lack of social support, moderate intellectual disability, stable neurological condition, mild dementia, a psychiatric condition controlled on medications, and limited mobility.

Results:

The only scenario that elicited an overwhelmingly negative response was mild dementia with 73.9% of participants unwilling to consider such patients for KTx. By contrast, the proportion of KTx professionals reluctant to proceed with KTx in the remaining scenarios ranged between 40.0% and 50.6%.

Conclusions:

This survey of a large number of KTx professionals suggests that there is presently no best practice consensus regarding offering KTx to patients living in LTC settings. Further research should include a broader range of KTx professionals and should also include a study of outcomes with KTx in this particular patient population.

Keywords

kidney transplantation long-term care quality of life resource allocation older adults patient selection

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