Dr Alison Weightman1, MS EMILY DUNCANSON5, DR SIMON COGHLAN4, A/PROF PHILIP CLAYTON1
1ANZDATA, Adelaide, Australia, 2Adelaide Medical School, University of Adelaide, Adelaide, Australia, 3Central and Northern Adelaide Renal and Transplantation Service, Adelaide, Australia, 4Centre for Artificial Intelligence and Digital Ethics, School of Computing and Information Systems, University of Melbourne, Melbourne, Australia, 5School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
Biography:
Alison is in the final year of her PhD on Transplantation Ethics, focusing on autonomy and informed consent at the time of deceased donor kidney transplant offers. She is also a part time clinical nephrologist working at both the Royal Adelaide Hospital and Flinders Medical Centre in South Australia.
Background:
Transplant allocation systems are increasingly using prognosis matching, where donor kidneys are paired with recipients of similar age, health status and life expectancy. While this approach aims to maximise life years saved per donation, it also raises fairness concerns due to the prioritisation of younger patients for higher-quality organs.
Aim:
We sought to understand nephrologist views on the use of prognosis matching in deceased donor transplant kidney allocation.
Methods:
50 nephrologists from Australia and New Zealand participated in semi-structured interviews. Transcripts were thematically analysed.
Results:
Most nephrologists were supportive of prognosis matching and emphasised the importance of allocating high quality donor kidneys to younger, healthier recipients in preference to older, more marginal recipients. Young recipients were perceived as more deserving of high quality transplants because of their longer anticipated lifespan and the potential for greater future contributions to society (e.g. through employment). Many nephrologists described feeling disappointed when high quality kidneys from young donors were allocated to older recipients, viewing it as inefficient use of resources. However, some nephrologists questioned the fairness of reducing access to high quality donor kidneys for older, marginal recipients, due to concern about increasing the risk of poor transplant outcomes for this cohort. Many nephrologists favoured integration of prognosis matching into the allocation algorithm, as this allowed them to focus on patient advocacy without the burden of weighing up the broader societal implications of an offer.
Conclusions:
Nephrologists generally supported prognosis matching in deceased donor kidney transplant allocation, citing its utility and the moral acceptability of prioritising younger recipients. However, as prognosis matching becomes more prominent in allocation systems, concerns about age-related discrimination persist and warrant further investigation.
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