Waitlist management for inactive status kidney transplant patients: a scoping review

Over 808 000 people live with end-stage renal disease (ESRD) in the United States. Kidney transplantation (KT) is the preferred treatment for ESRD, offering patients the best chance for long-term survival and improved quality of life compared to prolonged dependence on dialysis. There are nearly 90 000 people on the waitlist for transplant, but nearly half (47%) of patients on the KT waitlist are classified as inactive. Patients on the inactive KT waitlist have an elevated risk of post-transplant mortality and adverse outcomes. Reducing the time patients remain on the inactive KT waitlist is critical for transplant centers. Managing the waitlist for more than 250 kidney transplant programs in the US is resource and personnel intensive, and there are no best practice guidelines. Using the Johns Hopkins Nursing for Evidence-Based Practice Model as a guide, this scoping review examines the available literature on best practices for waitlist management for inactive status adult kidney transplant patients. Two themes were identified: (1) recognizing barriers to reactivation and (2) improved communication. The persistent challenges associated with inactive patients on the KT waitlist underscore the need for targeted interventions and a holistic, patient-centric approach. This review contributes to the limited literature on waitlist management for inactive KT patients and gives insights for future research, policy initiatives, and strategies to optimize the efficiency and equity of managing inactive status KT patients.