Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
*Purpose: Despite the benefits of living donor kidney transplantation (LDKT), rates have stagnated. Efforts to increase LDKT have focused on patient level barriers. Health professionals (HPs) play an important role in the decision to pursue LDKT, but barriers they identify and experience are rarely addressed. The objective of this study was to identify, quantify, and compare HP-level barriers across three provinces in Canada with low, moderate, and high LDKT rates. We hypothesized that HP-level barriers directly correlate with LDKT rates.
*Methods: We first conducted a preliminary qualitative study to explore barriers HPs experience when discussing LDKT with patients. Thematic analysis was used to analyze data from interviews and these interviews were conducted until saturation was obtained. Using this data, we identified predominant themes, which were used to create a 24-item survey instrument. We calculated the required survey sample size to be 85 participants per province. Recruitment entailed purposive criterion sampling.
*Results: In our qualitative analysis, we interviewed 16 HPs and six predominant themes of HP identified barriers to LDKT were identified and developed (Table 1). Following this, a survey was created and pilot tested with 19 HPs, leading to our preliminary results. Amongst the current respondents, 89% believe LDKT to be the gold standard for patients with end stage renal disease (ESRD). Only 16% of HPs perceive themselves as a part of both dialysis and transplant teams while 79% felt they belonged to either the dialysis team or the transplant team. Seventy-nine percent of respondents felt that dialysis and pre-dialysis should be responsible for LDKT promotion. Also, 16% felt promoting LDKT was not a part of their current role. Two-thirds felt comfortable discussing LDKT with patients and donors, yet 53% of participants said that donors had lower or no difference in ESRD rates post-donation. More than half of respondents reported that they would discuss LDKT more with patients if they had more resources. None of the respondents believe it is ethically unacceptable to take a kidney from a healthy person; however 11% reported knowing other HPs who have a negative attitude towards LDKT. While many HPs in our qualitative study reported patient level factors as impediments to discussions about LDKT, 88% would not change their recommendation or encourage patients to pursue LDKT over deceased donation unless a patient’s cultural background opposed LDKT. In that case, about 53% were less likely to recommend LDKT. Recruitment is still ongoing to reach the sample target to conduct a final comparative assessment across provinces.
*Conclusions: Education and training for HPs on LDKT may significantly correlate with LDKT rates. Poor role perception is a major barrier to LDKT and dedicated personnel championing LDKT may improve living donation rates. These results will inform future prospective intervention trials.
To cite this abstract in AMA style:Iskander R, Cantarovich M, Dendukuri N, Fortin M, Sandal S. Health Professional Level Barriers to Living Donor Kidney Transplantation: A Mixed Methods Study [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/health-professional-level-barriers-to-living-donor-kidney-transplantation-a-mixed-methods-study/. Accessed September 22, 2020.
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