Barriers to living donor kidney transplantation include poor communication, training
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A survey of Canadian health professionals revealed poor communication and a lack of education and training as barriers to living donor kidney transplantation, according to data published in Kidney International Reports.
Further, poor role perception, limited resources and poor infrastructure might be “driving differences” in the real-world setting of living donor kidney transplantation (LDKT).
“LDKT is the preferred therapeutic option for patients with end-stage kidney disease and is cost-effective for health care systems when compared with dialysis,” Shaifali Sandal, MD, from the division of nephrology in the department of medicine at McGill University Health Centre in Canada, and colleagues wrote. They added, “Thus, we aimed to quantify system-level barriers to LDKT that we have previously identified in our qualitative work and estimate their association with LDKT performance. We also aimed to determine if health professionals’ characteristics influenced responses and what health professionals thought should be priorities to increase LDKT.”
Sandal and colleagues conducted a cross-sectional survey of health professionals specifically involved in the care of patients with kidney failure or those who manage transplantation between July 15 to Sept. 14, 2021.
Participants rated statements in the survey on a Likert scale of strongly disagree to strongly agree. With the responses, researchers aimed to determine themes related to communication, role perception, education/training/comfort, attitudes, referral process, patient and resources/infrastructure.
“We also sought to analyze if four well-recognized baseline characteristics of the health professional that are known to influence care provision were associated with the level of agreement: the role of participant, years of experience, self-reported gender and race,” Sandal and colleagues wrote.
Researchers then analyzed the relationship between a health professional’s characteristic and their level of agreement with each statement.
A total of 353 complete survey responses were submitted, and answers revealed poor role perception and lack of multidisciplinary involvement as the most important barriers to LDKT. Approximately 35% of participants were from low-performing provinces and 29.2% were physicians. Health professionals from low-performing provinces had 73% lower odds of agreeing that their province promoted LDKT and 71% lower odds of agreeing that they initiated discussions about LDKT when compared with health professionals from high-performing provinces. However, they were less likely to agree that the transplant team is best to discuss LDKT and to agree that more resources would increase LDKT discussions.
Researchers identified nonphysician roles and less than 10 years of experience correlated with the level of agreement across various themes. The highest ranked priorities to increase LDKT were creating guidelines, streamlining evaluations and improving communication.
“Our findings have policy implications and can build on the current patient-level work that others are pursuing to increasing LDKT,” Sandal and colleagues wrote. “We recommend that interventions specifically designed to eliminate these system-level barriers should be implemented in conjunction to patient-level interventions as part of the ‘LDKT first’ strategy for the treatment of end-stage kidney disease.”
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