Priority setting in kidney transplantation: a qualitative study evaluating Swedish practices.

Area of Science:

• Nephrology
• Transplantation Medicine
• Health Policy

Background:

• Kidney transplantation is the optimal treatment for end-stage renal disease, improving survival and quality of life.
• The scarcity of donor kidneys necessitates robust priority-setting processes.
• Swedish kidney transplantation practices were evaluated against the Accountability for Reasonableness (A4R) framework.

Purpose of the Study:

• To investigate the fairness of priority setting in Swedish kidney transplantation.
• To assess the alignment of current practices with the Accountability for Reasonableness (A4R) framework.

Main Methods:

• Conducted 15 semi-structured interviews with transplant surgeons, nephrologists, and coordinators nationwide.
• Analyzed interview data using thematic analysis.
• Assessed identified factors against the four conditions of the A4R framework: publicity, relevance, revision and appeal, and enforcement.

Main Results:

• Decision-making in kidney assessment and allocation balances values like maximizing benefit, prioritizing the worst-off, and equality.
• Identified factors align with the relevance condition of the A4R framework.
• Clinical judgment and institutional policies emerged as potential sources of unfair inequalities in treatment access.

Conclusions:

• Developing national guidelines for transplant candidacy assessment and deceased donor kidney allocation is recommended.
• Standardizing practices across centers can enhance fairness according to the A4R framework.
• Policy proposals for Swedish kidney transplantation warrant careful consideration.