Decision-making about suitability for kidney transplantation: Results of a national survey of Australian nephrologists.
OBJECTIVE
This study aimed to elucidate the factors affecting nephrologists' decision-making on patients' suitability for kidney transplantation. Given the reduced access to transplantation for Indigenous Australians, the role of patient's ethnicity was of particular interest.


METHODS
A postal survey of practising nephrologists and trainees was undertaken in Australia. Each participant was provided with a unique set of 15 hypothetical patient descriptions, with demographic, clinical and behavioural factors randomly generated to ensure an overall balance of factors across the cases. The main outcome measure was whether kidney transplantation was recommended.


RESULTS
Responding nephrologists and trainees were more likely to recommend transplantation for hypothetical patients who were young, of normal weight and described as compliant. They were less likely to recommend transplantation for smokers, or for people with diabetes or heart disease. No significant differences related to the patients' sex or ethnicity. The geographical location of the respondent was a significant determinant, with differences according to their State/Territory and their metropolitan/non-metropolitan location.


CONCLUSIONS
When all other factors were held constant, nephrologists and trainees appear to base their decision-making regarding suitability for transplant on clinical and behavioural factors, rather than on the basis of ethnicity or sex. In practice, however, clinical and behavioural factors cluster with ethnicity, and this is likely to contribute to the current poor access to transplantation for Indigenous end-stage kidney disease patients. Apparent differences in decision-making according to the respondent's location may reflect variations in practice across the country.
Cass
Alan
A
The George Institute for International Health, Central Clinical School, University of Sydney, and Statewide Renal Services, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. acass@george.org.au
Cunningham
Joan
J
Anderson
Kate
K
Snelling
Paul
P
Colman
Sam
S
Devitt
Jeannie
J
Preece
Cilla
C
Eris
Josette
J
D001291:Attitude of Health Personnel; D001315:Australia; D003657:Decision Making; D006801:Humans; D016030:Kidney Transplantation / Q000523:psychology*; D009398:Nephrology / Q000592:standards*; D018579:Patient Selection; D011795:Surveys and Questionnaires