A WEIGHTMAN1,2, P CLAYTON1,2,3, S COGHLAN4
1University Of Adelaide, Adelaide, Australia, 2Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, South Australian Health and Medical Research Institute (SAHMRI), Adelaide, Australia, 3Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia, 4University of Melbourne, Melbourne, Australia
Aim: To critically analyse current practices and published literature on stakeholder preferences for doctor and patient roles in kidney transplant offers.
Background: There are growing calls for greater implementation of shared decision making in kidney transplantation. While there has been considerable interest in patient, doctor and community preferences for organ allocation practices, offer acceptance procedures have been largely overlooked.
Methods: A multi-modal literature review was conducted. Australian and international transplantation clinical and ethical guidelines were identified from official online sources. Scientific databases including MEDLINE, PsychInfo, Scopus and Embase were also searched for publications on preferences and opinions of doctors and patients regarding decision making in kidney transplantation offers.
Results: International guidelines contain paternalistic recommendations regarding decision making during kidney transplant offers, assigning sole authority to transplant doctors with limited opportunity for meaningful patient involvement. Australian transplantation guidelines do not specify stakeholder roles and responsibilities. Several surveys and interview based studies conducted in international populations have found the majority of patients would prefer greater involvement in transplant decision-making, however doctors believe these decisions should be left to the medical team. Comparison of doctor and patient preferences for transplant organ selection indicate divergence in priorities and risk tolerance between these two groups.
Conclusion: Unlike their international counterparts, Australian kidney transplant guidelines do not include recommendations regarding patient input into decision making for kidney transplant offers. Overseas studies of patient preferences suggest there is an opportunity to increase patient involvement in these decisions. In order to address this gap in a manner reflective of desired practice in Australia, we first need to better understand the views and priorities of Australian patients and doctors.
Dr Alison Weightman is a South Australian nephrologist with an interest in Bioethics and Kidney Transplantation. She is based at SAHMRI but also works part time at Flinders Medical Centre. She has recently commenced her PhD on Decision-Making in Transplantation where she will be combining ethical analysis with qualitative methodologies.