Defining the ethical considerations surrounding kidney transplantation for frail and cognitively impaired patients: a Delphi study of geriatric transplant experts.
Defining the ethical considerations surrounding kidney transplantation for frail and cognitively impaired patients: a Delphi study of geriatric transplant experts.
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DOI：
10.1186/s12877-022-03209-x
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发表时间：
2022-07-08
期刊：
影响因子：
4.1
通讯作者：
McAdams-DeMarco, Mara
中科院分区：
文献类型：
--
作者：
Shrestha, Prakriti;Rasmussen, Sarah E. Van Pilsum;King, Elizabeth A.;Gordon, Elisa J.;Faden, Ruth R.;Segev, Dorry L.;Humbyrd, Casey Jo;McAdams-DeMarco, Mara
Among adult kidney transplant (KT) candidates, 21% are frail and 55% have cognitive impairment, increasing the risk of pre- and post-KT mortality. Centers often assess frailty status and cognitive function during transplant evaluation to help identify appropriate candidate. Yet, there are no ethical guidelines regarding the use of frailty and cognitive function during this evaluation. We seek to develop a clinical consensus on balancing utility and justice in access to KT for frail and cognitively impaired patients. Twenty-seven experts caring for ESRD patients completed a two-round Delphi panel designed to facilitate consensus (> 80% agreement). Experts believed that denying patients transplantation based solely on expected patient survival was inequitable to frail or cognitively impaired candidates; 100% agreed that frailty and cognitive impairment are important factors to consider during KT evaluation. There was consensus that health related quality of life and social support are important to consider before waitlisting frail or cognitively impaired patients. Experts identified important factors to consider before waitlisting frail (likely to benefit from KT, frailty reversibility, age, and medical contraindications) and cognitively impaired (degree of impairment and medication adherence) patients. Clinical experts believed it was ethically unacceptable to allocate organs solely based on patients’ expected survival; frailty and cognitive impairment should be measured at evaluation when weighed against other clinical factors. Ethical guidelines regarding the use of frailty and cognitive function during KT evaluation ought to be developed. The online version contains supplementary material available at 10.1186/s12877-022-03209-x.
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影响因子：
4.2
作者：
Chu, Nadia M.;Chen, Xiaomeng;McAdams-DeMarco, Mara A.
通讯作者：
McAdams-DeMarco, Mara A.
影响因子：
13.6
作者：
Chu, Nadia M.;Gross, Alden L.;McAdams-DeMarco, Mara A.
通讯作者：
McAdams-DeMarco, Mara A.
影响因子：
16.9
作者：
Kulkarni, Sanjay;Ladin, Keren;Deng, Yanhong
通讯作者：
Deng, Yanhong
影响因子：
6.3
作者：
McAdams-DeMarco MA;Isaacs K;Darko L;Salter ML;Gupta N;King EA;Walston J;Segev DL
通讯作者：
Segev DL
影响因子：
3.8
作者：
Hasson, F;Keeney, S;McKenna, H
通讯作者：
McKenna, H