Older adults with kidney disease face psychosocial barriers in transplant evaluation
Key takeaways:
- Patients and their families felt personal responsibility to navigate the transplantation process.
- At the same time, participants felt little power to influence evaluation outcomes.
Older adults with advanced kidney disease are often motivated to receive a transplant but may face emotional and psychosocial barriers during evaluation, according to a study.
“To promote broader and more equitable access to kidney transplant, many members of the transplant community have called for more proactive and inclusive approaches to transplant referral,” Catherine R. Butler, MD, MA, assistant professor of medicine in the division of nephrology in the department of medicine at the University of Washington in Seattle, wrote with colleagues. “While this approach may afford more older adults with kidney failure an opportunity to be considered for transplant, it may also have the unintended consequence of drawing a greater number of older adults into a lengthy and demanding process without their receiving a kidney.”
Researchers interviewed 26 adults with advanced kidney disease and seven of their family members between 2022 and 2024. Patients in the Seattle-based cohort had an eGFR of 20 mL/min/1.73 m2 or lower, were on dialysis or had a functioning kidney transplant. Overall, 61.5% of the patients were men, and median age was 68 years; and of the family members, 57.1 were women, and median age was 65 years.
“In this context, it is especially important to understand what the kidney transplant evaluation is like for older adults,” the researchers wrote, “and whether there are opportunities to better support those contemplating or engaged in this process.”
Through inductive thematic analysis of semi-structured interviews, Butler and colleagues found three key themes among the overall group: commitment to completing transplantation; learning the evaluation process may be complex; and a sense of personal responsibility to navigate the process while feeling little power to influence its direction.
Most participants were willing to endure the testing and treatment process with the hope of receiving a kidney, the researchers found, but they said they felt overwhelmed by the length and demanding nature. Many expressed that the system could feel fragmented and opaque and require them to pause other life activities while waiting for uncertain outcomes.
Further, participants reported a dueling sense of obligation, coupled with dependency on clinical teams. They expressed this dynamic can leave them feeling isolated and strained and add another emotional burden to the relationship with their family members.
“These findings underline the importance of educating older adults with kidney failure and their family members about what to expect from the transplant evaluation process and redesigning this process to be more transparent and person centered,” the researchers wrote.
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