Public health service increased risk donor kidney grafts for transplant into children, a survey of pediatric nephrologists

• Published in: Pediatric transplantation 2021-03, Vol.25 (2), p.e13863-n/a
• Main Authors: Anderson, Blaire, Jezewski, Emily, Sela, Nathalie, Westphal, Scott, Hoffman, Arika
• Format: Article
• Language: English
• Subjects: Adolescent; Attitude of Health Personnel; Child; Child, Preschool; Children; Counseling; donor; Donor Selection - methods; Donor Selection - standards; Female; Health services; Humans; increased risk; Infant; Infant, Newborn; kidney; Kidney Failure, Chronic - surgery; Kidney Transplantation; Kidney transplants; Male; Nephrologists; Nephrology; Pediatrics; Public health; Risk; Surveys and Questionnaires; Tissue Donors - supply & distribution; transplant; United States; United States Public Health Service
• ISSN: 1397-3142; 1399-3046
• DOI: 10.1111/petr.13863

Background Kidney transplant is the best treatment for end‐stage renal disease (ESRD); however, access is limited by severe organ shortage. Public Health Service increased risk donors (PHS‐IRD) represent a significant portion of available organs which are discarded at disproportional rates. Methods Pediatric nephrologists were surveyed regarding PHS‐IRD kidneys to understand attitudes and perceived barriers to the use of these grafts in children. We sought to elucidate what methods may help increase the likelihood of PHS‐IRD acceptance. Results Twenty‐two responses were received from United States pediatric nephrologists representing 11 UNOS regions (response rate 5.9%). Of respondents, 50% had been practicing for 20+ years, 77% in academic hospitals, and 63% in cities with over 1 000 000 people. All respondents worked in an institution with a kidney transplant program. 41% reported that they would not accept PHS‐IRD kidneys under any circumstance, 45% would accept depending on the candidate's medical status, and 14% routinely accepted PHS‐IRD kidneys. Infectious transmission was the biggest disincentive reported (59%), with only 55% of respondents feeling comfortable counseling families on the associated risks. 82% of respondents did not perceive all PHS‐IRD as the same, and 90% supported stratifying PHS‐IRD into tiers based on risk, which would increase the likelihood of organ acceptance (82%) and assist in counseling families (91%). Conclusions With improved utilization, PHS‐IRD kidneys offer a step toward decreasing the organ shortage. These findings suggest hesitance in use of PHS‐IRD kidneys for pediatric recipients. Further stratification of risk could aid in provider organ acceptance and counseling patients.