title: Attitudes of minority patients with end-stage renal disease regarding ABO-incompatible list-paired exchanges.
abstract: A few transplant centers in the United States have implemented list-paired exchange programs that include both ABO-compatible and ABO-incompatible living-donor recipients. ABO-incompatible list-paired exchanges raise ethical concerns because they increase the total number of organs available but increase the waiting time for wait-list candidates of blood type O. In this manuscript, we explore attitudes of a convenience sample of minority patients with end-stage renal disease (ESRD) regarding living paired exchanges, ABO-compatible and ABO-incompatible list-paired exchanges and ABO-incompatible direct transplants. Data from 87 minority respondents were analyzed. Eighty-seven (100%) supported living paired exchanges and ABO-compatible list-paired exchanges. In contrast, only 50 of 85 (59%) respondents supported ABO-incompatible list-paired exchanges (p < 0.001), including half (12 of 24) of those with blood type O. Subjects were asked how much additional time it would be fair to ask wait-list candidates of blood type O to wait to implement ABO-incompatible list-paired exchanges. Forty percent (35 of 87) responded 'no additional time' and another 10% (9 of 87) responded 'one month or shorter'. Minority dialysis patients hold mixed opinions about the fairness of ABO-incompatible list-paired exchanges. If our findings are confirmed in a more diverse randomly selected sample, then the UNOS variances that permit these exchanges should be reconsidered.
authors.affiliation: Loyola University Stritch School of Medicine, Maywood, IL, USA.
authors.forename: P D
authors.initials: PD
authors.lastname: Ackerman
authors.forename: J R
authors.initials: JR
authors.lastname: Thistlethwaite
authors.forename: L F
authors.initials: LF
authors.lastname: Ross
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health / Q000208:ethnology; D033001:Directed Tissue Donation / Q000941:ethics*; D005260:Female; D006648:Histocompatibility / Q000941:ethics*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology / Q000523:psychology* / Q000628:therapy; D016030:Kidney Transplantation / Q000941:ethics* / Q000208:ethnology; D019520:Living Donors / Q000523:psychology* / Q000600:supply & distribution; D008297:Male; D008875:Middle Aged; D008913:Minority Groups / Q000523:psychology*; D014850:Waiting Lists
chemical_list: D000017:ABO Blood-Group System