title: Priority setting in kidney transplantation: a qualitative study evaluating Swedish practices.
abstract: BACKGROUND
  Transplantation is the treatment of choice for end-stage renal disease; it increases survival and quality of life, while being more cost-effective than dialysis. It is, however, limited by the scarcity of kidneys. The aim of this paper is to investigate the fairness of the priority setting process underpinning Swedish kidney transplantation in reference to the Accountability for Reasonableness (A4R) framework.
  
  
  METHODS
  Fifteen semi-structured interviews were carried out with transplant surgeons (7), nephrologists (6) and coordinators (2) representing centers nationwide. Collected data was analysed using thematic analysis. To assess fairness in the priority setting process, identified factors were assessed in the reference to the four conditions (publicity, relevance, revision and appeal, enforcement) forming the accountability for reasonableness framework.
  
  
  RESULTS
  Decision-making in assessment and allocation is based on clusters of factors. The factors appeal to various values, which are balanced against each other throughout the kidney allocation process: maximizing benefit, priority to the worst off and equality. The factors described by subjects and the values on which they rest satisfy the relevance condition of the accountability for reasonableness framework. However, two potential sources for unfair inequalities in access to treatment are identified: clinical judgment and institutional policies.
  
  
  CONCLUSIONS
  The development of national guidelines both for assessing transplant candidacy, and for the allocation of kidneys from deceased donors, would contribute to standardize practices across centres; it will also help to better meet the conditions of fairness in reference to Accountability for Reasonableness. The benefits of this policy proposal in Swedish kidney transplantation merits consideration.
authors.affiliation: Department of Medical and Health Sciences Linköping University, Sweden. faisal.omar@liu.se
authors.forename: Faisal
authors.initials: F
authors.lastname: Omar
authors.forename: Gustav
authors.initials: G
authors.lastname: Tinghög
authors.forename: Per
authors.initials: P
authors.lastname: Carlsson
authors.forename: Marie
authors.initials: M
authors.lastname: Omnell-Persson
authors.forename: Stellan
authors.initials: S
authors.lastname: Welin
mesh_terms: D016000:Cluster Analysis; D003657:Decision Making / Q000941:ethics*; D005260:Female; D015276:Health Care Rationing / Q000941:ethics*; D006282:Health Personnel / Q000523:psychology*; D006292:Health Priorities / Q000941:ethics*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D016030:Kidney Transplantation; D008297:Male; D036301:Qualitative Research; D012935:Social Justice; D012941:Social Responsibility; D013548:Sweden; D014850:Waiting Lists