title: The preferences and perspectives of nephrologists on patients' access to kidney transplantation: a systematic review.
abstract: We aimed to describe nephrologists' attitudes to patients' access to kidney transplantation. Studies that assessed nephrologists' perspectives toward patient referral, screening, and eligibility for kidney transplantation were synthesized. Twenty-four studies (n≥4695) were included. Patients with comorbidities, were nonadherent, of older age, ethnic minorities, or low socioeconomic status were less likely to be recommended. Six themes underpinned nephrologists' perspectives: prioritizing individual benefit and safety, maximizing efficiency, patient accountability, justifying gains, protecting unit outcomes, and reluctance to raise patients' expectations. Evidence-based guidelines may support systematic and equitable decision-making. Interventions for high-risk or disadvantaged patient populations could reduce disparities in access to transplantation.
authors.affiliation: 1 Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia. 2 Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, NSW, Australia. 3 Centre for Transplant and Renal Research, Westmead Hospital, NSW, Westmead, Australia. 4 Department of Nephrology, Charité-Universitätsmedizin, Berlin, Germany. 5 Department for Psychosomatic Medicine, Charité-Universitätsmedizin, Berlin, Germany. 6 Address correspondence to: Allison Tong, Ph.D., Centre for Kidney Research, The Children's Hospital at Westmead, Westmead NSW 2145, Australia.
authors.forename: Allison
authors.initials: A
authors.lastname: Tong
authors.forename: Camilla S
authors.initials: CS
authors.lastname: Hanson
authors.forename: Jeremy R
authors.initials: JR
authors.lastname: Chapman
authors.forename: Fabian
authors.initials: F
authors.lastname: Halleck
authors.forename: Klemens
authors.initials: K
authors.lastname: Budde
authors.forename: Christina
authors.initials: C
authors.lastname: Papachristou
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Craig
mesh_terms: D000368:Aged; D001291:Attitude of Health Personnel; D015897:Comorbidity; D003657:Decision Making; D019317:Evidence-Based Medicine; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation; D008019:Life Style; D008297:Male; D008875:Middle Aged; D009398:Nephrology / Q000379:methods*; D017063:Outcome Assessment, Health Care; D010358:Patient Participation; D010820:Physicians; D010818:Practice Patterns, Physicians'; D011788:Quality of Life; D012017:Referral and Consultation; D012923:Social Class; D035862:Vulnerable Populations