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Kidney transplant candidates’ views of the transplant allocation system

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Abstract

Objectives

The point system used to distribute scarce transplantable kidneys places great emphasis on antigen matching. This contributes to increased waiting times for African Americans, who have a disporoportionate share of rare antigens. We conducted a pilot study to explore the understanding and attitudes of kidney transplant candidates toward the way the transplant allocation system trades off between antigen matching and waiting time.

Measurements and main Results

We performed semistructured interviews of a convenience sample of 33 patients awaiting transplants in Philadelphia and its surrounding suburbs. Patients had a number of misconceptions about the transplant allocation system. Many incorrectly thought, for example, that quality of life and finacial status influence which patients on the walting list receive available organs. Despite these and other misconceptions, the majority of patients thought the allocation system was fair. However, many African Americans thought the system was biased against them because of their race. After hearing about how the transplant system factors antigen matching and waiting time into organ allocation, the majority of subjects still felt the system was fair. After hearing that the emphasis on antigen matching causes African Americans to wait twice as long as whites, a larger number of subjects thought the system was unfair. Nevertheless, few thought the system should be changed. Even African American patients who felt the system was unfair still approved of the emphasis on antigen matching out of a desire to have a successful kidney transplant.

Conclusions

We found that most of the interviewed patients awaiting kidney transplant thought the system should continue to emphasize antigen matching. Although attitudes toward the allocation system differed by race, with African American patients more suspicious of the system, the importance patients placed on antigen matching did not appear to differ by race.

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Author information

Authors and Affiliations

  1. Department of Emergency Medicine, Johns Hopkins University, Baltimore, Md

    Okiki N. Louis MD

  2. Center for Bioethics, University of Pennsylvania School of Medicine, University of Pennsylvania, 3401 Market St., Suite 320, 19104-3308, Philadelphia, PA

    Pamela Sankar PhD & Peter A. Ubel MD

  3. Division of General Internal Medicine, University of Pennsylvania School of Medicine, University of Pennsylvania, Philadelphia

    Peter A. Ubel MD

  4. Veterans Affairs Medical Center, University of Pennsylvania, Philadelphia

    Peter A. Ubel MD

  5. Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia

    Pamela Sankar PhD & Peter A. Ubel MD

Authors
  1. Okiki N. Louis MD
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  2. Pamela Sankar PhD
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  3. Peter A. Ubel MD
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Additional information

Supported in part by a grant from the Annenberg Public Policy Foundation through its support of the Center for Bioethics’ Project on Informed Consent. Dr. Louis’ work was supported by the National Medical Fellowship Program in Academic Medicine. Dr. Ubel is a Measey Foundation Faculty Fellow and the recipient of a Career Development Award from the Department of Veterans Affairs Health Services Research and Development Service.

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Louis, O.N., Sankar, P. & Ubel, P.A. Kidney transplant candidates’ views of the transplant allocation system. J GEN INTERN MED 12, 478–484 (1997). https://doi.org/10.1046/j.1525-1497.1997.00086.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.1997.00086.x

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