Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
BMC Nephrology
Published in: BMC Nephrology 1/2023

Open Access 01-12-2023 | Research article

Adding epitope compatibility to deceased donor kidney allocation criteria: recommendations from a pan-Canadian online public deliberation

Authors: Louisa Edwards, Colene Bentley, Michael Burgess, Ruth Sapir-Pichhadze, David Hartell, Paul Keown, Stirling Bryan

Published in: BMC Nephrology | Issue 1/2023

Login to get access

Abstract

Background

The widening supply–demand imbalance for kidneys necessitates finding ways to reduce rejection and improve transplant outcomes. Human leukocyte antigen (HLA) epitope compatibility between donor and recipient may minimize premature graft loss and prolong survival, but incorporating this strategy to deceased donor allocation criteria prioritizes transplant outcomes over wait times. An online public deliberation was held to identify acceptable trade-offs when implementing epitope compatibility to guide Canadian policymakers and health professionals in deciding how best to allocate kidneys fairly.

Methods

Invitations were mailed to 35,000 randomly-selected Canadian households, with over-sampling of rural/remote locations. Participants were selected for socio-demographic diversity and geographic representation. Five two-hour online sessions were held from November–December 2021. Participants received an information booklet and heard from expert speakers prior to deliberating on how to fairly implement epitope compatibility for transplant candidates and governance issues. Participants collectively generated and voted on recommendations. In the final session, kidney donation and allocation policymakers engaged with participants. Sessions were recorded and transcribed.

Results

Thirty-two individuals participated and generated nine recommendations. There was consensus on adding epitope compatibility to the existing deceased donor kidney allocation criteria. However, participants recommended including safeguards/flexibility around this (e.g., mitigating declining health). They called for a transition period to epitope compatibility, including an ongoing comprehensive public education program. Participants unanimously recommended regular monitoring and public sharing of epitope-based transplant outcomes.

Conclusions

Participants supported adding epitope compatibility to kidney allocation criteria, but advised safeguards and flexibility around implementation. These recommendations provide guidance to policymakers about incorporating epitope-based deceased donor allocation criteria.
Appendix
Available only for authorised users
Literature
1.
2.
3.
Tonelli M, Wiebe N, Knoll G, Bello A, Browne S, Jadhav D, et al. Kidney transplantation compared with dialysis in clinically relevant outcomes: systematic review of kidney transplantation. Am J Transplant. 2011;11(10):2093–109.CrossRefPubMed
4.
Ferguson TW, Whitlock RH, Bamforth RJ, Beaudry A, Darcel J, Di Nella M, et al. Cost-utility of dialysis in Canada: hemodialysis, peritoneal dialysis, and nondialysis treatment of kidney failure. Kidney Med. 2021;3(1):20-30.e1.CrossRefPubMed
5.
6.
7.
Steffel M, Williams EF, Tannenbaum D. Does changing defaults save lives? Effects of presumed consent organ donation policies. Behav Sci Policy. 2019;5(1):68–88.CrossRef
8.
Pancer E, Beed S, Tennankore K, Weiss MJ. 421.6: Rates of Effective Intent-To-Donate in Nova Scotia: Mitigation of Differences by Gender and Age After Enactment of Deemed Consent Legislation. Transplantation. 2022;106(9S):S454–S454.CrossRef
9.
Canadian Institute for Health Information. Treatment of End-Stage Organ Failure in Canada, Canadian Organ Replacement Register, 2011 to 2020: End-Stage Kidney Disease and Kidney Transplants - Data Tables. Ottawa, ON: CIHI; 2021.
10.
Canadian Organ Replacement Register (2021). [Unadjusted 15-year Graft Survival Rates in Adult Kidney Transplant Recipients, Deceased Donor, First Graft, Canada (excluding Quebec)] [Unpublished percentage data]. Canadian Institute for Health Information.
11.
12.
Sellarés J, de Freitas DG, Mengel M, Reeve J, Einecke G, Sis B, et al. Understanding the causes of kidney transplant failure: the dominant role of antibody-mediated rejection and nonadherence: attributing causes of kidney transplant loss. Am J Transplant. 2012;12(2):388–99.CrossRefPubMed
13.
Mohammadhassanzadeh H, Oualkacha K, Zhang W, Klement W, Bourdiec A, Lamsatfi J, et al. On path to informing hierarchy of eplet mismatches as determinants of kidney transplant loss. Kidney Int Rep. 2021;6(6):1567–79.CrossRefPubMedPubMedCentral
14.
Senev A, Coemans M, Lerut E, Van Sandt V, Kerkhofs J, Daniëls L, et al. Eplet mismatch load and de novo occurrence of donor-specific anti-HLA antibodies, rejection, and graft failure after kidney transplantation: an observational cohort study. J Am Soc Nephrol. 2020;31(9):2193–204.CrossRefPubMedPubMedCentral
15.
Sapir-Pichhadze R, Zhang X, Ferradji A, Madbouly A, Tinckam KJ, Gebel HM, et al. Epitopes as characterized by antibody-verified eplet mismatches determine risk of kidney transplant loss. Kidney Int. 2020;97(4):778–85.CrossRefPubMed
16.
Wiebe C, Kosmoliaptsis V, Pochinco D, Gibson IW, Ho J, Birk PE, et al. HLA - DR / DQ molecular mismatch: a prognostic biomarker for primary alloimmunity. Am J Transplant. 2019;19(6):1708–19.CrossRefPubMed
17.
Heidt S, Haasnoot GW, Van Rood JJ, Witvliet MD, Claas FHJ. Kidney allocation based on proven acceptable antigens results in superior graft survival in highly sensitized patients. Kidney Int. 2018;93(2):491–500.CrossRefPubMed
18.
Heidt S, Haasnoot GW, Witvliet MD, van der Linden-van Oevelen MJH, Kamburova EG, Wisse BW, et al. Allocation to highly sensitized patients based on acceptable mismatches results in low rejection rates comparable to nonsensitized patients. Am J Transplant. 2019;19(10):2926–33.CrossRefPubMedPubMedCentral
19.
Kausman JY, Walker AM, Cantwell LS, Quinlan C, Sypek MP, Ierino FL. Application of an epitope-based allocation system in pediatric kidney transplantation. Pediatr Transplant. 2016;20(7):931–8.CrossRefPubMed
20.
Irving MJ, Tong A, Jan S, Wong G, Cass A, Allen RD, et al. Community preferences for the allocation of deceased donor organs for transplantation: a focus group study. Nephrol Dial Transplant. 2013;28(8):2187–93.CrossRefPubMed
21.
Oedingen C, Bartling T, Mühlbacher AC, Schrem H, Krauth C. Systematic review of public preferences for the allocation of donor organs for transplantation: principles of distributive justice. Patient. 2019;12(5):475–89.CrossRefPubMed
22.
23.
O’Doherty KC, Burgess MM. Engaging the public on biobanks: outcomes of the BC biobank deliberation. Public Health Genomics. 2009;12(4):203–15.CrossRefPubMed
24.
Rychetnik L, Carter SM, Abelson J, Thornton H, Barratt A, Entwistle VA, et al. Enhancing citizen engagement in cancer screening through deliberative democracy. JNCI J Natl Cancer Inst. 2013;105(6):380–6.CrossRefPubMed
25.
Teng J, Bentley C, Burgess MM, O’Doherty KC, McGrail KM. Sharing linked data sets for research: results from a deliberative public engagement event in British Columbia, Canada. Int J Popul Data Sci. 2019;4(1).
26.
27.
Goodin R, Dryzek J. Deliberative impacts: the macro-political uptake of mini-publics. Polit Soc. 2006;34(2):219–44.CrossRef
28.
Schwartz PH, O’Doherty KC, Bentley C, Schmidt KK, Burgess MM. Layperson views about the design and evaluation of decision aids: a public deliberation. Med Decis Making. 2021;41(5):527–39.CrossRefPubMedPubMedCentral
29.
30.
El-Dassouki N, Wong D, Toews DM, Gill J, Edwards B, Orchanian-Cheff A, et al. Barriers to accessing kidney transplantation among populations marginalized by race and ethnicity in Canada: a scoping review Part 1—Indigenous communities in Canada. Can J Kidney Health Dis. 2021;8:205435812199683.
31.
Moore A, O’Doherty K. Deliberative voting: clarifying consent in a consensus process: deliberative voting. J Polit Philos. 2014;22(3):302–19.CrossRef
32.
Slomp C, Edwards L, Burgess M, Sapir-Pichhadze R, Keown P, Bryan S. Public values and guiding principles for implementing epitope compatibility in kidney transplantation allocation criteria: results from a Canadian online public deliberation. BMC Public Health. 2023;23(1):844.CrossRefPubMedPubMedCentral
33.
Mitton C, Smith N, Peacock S, Evoy B, Abelson J. Public participation in health care priority setting: a scoping review. Health Policy. 2009;91(3):219–28.CrossRefPubMed
34.
Howard K, Jan S, Rose JM, Wong G, Irving M, Tong A, et al. Community preferences for the allocation of donor organs for transplantation: a discrete choice study. Transplantation. 2015;99(3):560–7.CrossRefPubMed
35.
Asghari F, Broumand M, Heidari A. Public preferences for donor kidney allocation: a study in Iran. Clin Transplant. 2013 Sep-Oct;27(5):718–23. Epub 9 Aug 2013.
36.
Organ Procurement and Transplantation Network. General Considerations in Assessment for Transplant Candidacy. US Department of Health & Human Services. Published online 2015. Provided upon request 1 Jul 2022.
37.
Gibbons A, Cinnirella M, Bayfield J, Wu D, Draper H, Johnson RJ, et al. Patient preferences, knowledge and beliefs about kidney allocation: qualitative findings from the UK-wide ATTOM programme. BMJ Open. 2017;7(1): e013896.CrossRefPubMedPubMedCentral
38.
Clark MD, Leech D, Gumber A, Moro D, Szczepura A, West N, et al. Who should be prioritized for renal transplantation?: Analysis of key stakeholder preferences using discrete choice experiments. BMC Nephrol. 2012;13(1):152.CrossRefPubMedPubMedCentral
39.
Oedingen C, Bartling T, Dierks M, Mühlbacher AC, Schrem H, Krauth C. Public preferences for the allocation of donor organs for transplantation: focus group discussions. Health Expect. 2020;23(3):670–80.CrossRefPubMedPubMedCentral
40.
Dolan P, Shaw R. A note on a discussion group study of public preferences regarding priorities in the allocation of donor kidneys. Health Policy. 2004;68(1):31–6.CrossRefPubMed
41.
Elalouf A, Pliskin JS, Kogut T. Attitudes, knowledge, and preferences of the Israeli public regarding the allocation of donor organs for transplantation. Isr J Health Policy Res. 2020;9(1):25.CrossRefPubMedPubMedCentral
42.
Tong A, Jan S, Wong G, Craig JC, Irving M, Chadban S, et al. Patient preferences for the allocation of deceased donor kidneys for transplantation: a mixed methods study. BMC Nephrol. 2012;13(1):18.CrossRefPubMedPubMedCentral
43.
Tong A, Howard K, Jan S, Cass A, Rose J, Chadban S, et al. Community preferences for the allocation of solid organs for transplantation: a systematic review. Transplantation. 2010;89(7):796–805.CrossRefPubMed
44.
Bentley C, Costa S, Burgess MM, Regier D, McTaggart-Cowan H, Peacock SJ. Trade-offs, fairness, and funding for cancer drugs: key findings from a deliberative public engagement event in British Columbia, Canada. BMC Health Serv Res. 2018;18(1):339.CrossRefPubMedPubMedCentral
45.
McClellan W, Warnock DG, McClure L, Campbell RC, Newsome BB, Howard V, et al. Racial differences in the prevalence of chronic kidney disease among participants in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort Study. J Am Soc Nephrol. 2006;17(6):1710–5.CrossRefPubMed
46.
47.
Metadata
Title
Adding epitope compatibility to deceased donor kidney allocation criteria: recommendations from a pan-Canadian online public deliberation
Authors
Louisa Edwards
Colene Bentley
Michael Burgess
Ruth Sapir-Pichhadze
David Hartell
Paul Keown
Stirling Bryan
Publication date
01-12-2023
Publisher
BioMed Central
Published in
BMC Nephrology / Issue 1/2023
Electronic ISSN: 1471-2369
DOI
https://doi.org/10.1186/s12882-023-03224-z

Other articles of this Issue 1/2023

BMC Nephrology 1/2023 Go to the issue

Case Report

Karyomegalic interstitial nephritis as a rare cause of kidney graft dysfunction: case report and review of literature

Research

Feasibility of Symptom monitoring WIth Feedback Trial (SWIFT) for adults on hemodialysis: a registry-based cluster randomized pilot trial

Research

Prevalence and predictors of chronic kidney disease of undetermined causes (CKDu) in Western Kenya’s “sugar belt”: a cross-sectional study

Research

Non-contrast low-dose CT can be used for volumetry of ADPKD

Research

The effect of fibrinoid necrosis on the clinical features and outcomes of primary IgA nephropathy

Research

Kidney dysfunction: prevalence and associated risk factors in a community-based study from the North West Province of South Africa
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

Read more

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Image Credits