In pursuit of improving kidney transplantation accessibility, health system leaders encourage nephrologists to enhance patient referrals for transplant evaluation. This study investigates the referral decisions of nephrologists, examining whether variations exist based on the nephrologist’s training vintage, particularly if those with more years of experience interpret patient criteria more restrictively. Employing a novel and rigorously validated survey distributed among U.S.-based nephrologists, the research focuses on criteria for evaluating adult patients’ suitability for transplant, including clinical (e.g., overweight) and psychosocial factors (e.g., insurance). The study quantifies the level of restrictiveness applied by nephrologists to these criteria. It explores the associations between restrictiveness and nephrologist age, acting as a proxy for training vintage through logistic regression models.
Among the 42 respondents from the 144 nephrologists invited (29% response rate), key findings indicate inconsistent interpretation of patient criteria, with lower consistency observed for psychosocial factors than clinical criteria. Moreover, as nephrologists age, the odds of interpreting criteria more restrictively increase, demonstrating a potential correlation between age and decision-making. Specifically, this relationship was statistically significant for psychosocial but not clinical criteria. The study sheds light on the variability in nephrologists’ assessments of transplant suitability, emphasizing the need for guideline-based educational interventions tailored to influence referral decision-making, considering the impact of age and training vintage on these decisions.
Understanding and addressing these variations could contribute to a more standardized and equitable approach to assessing patients for kidney transplantation, aligning with the broader goal of improving accessibility to this critical medical intervention.
Source: sciencedirect.com/science/article/pii/S2468024924000226