Provider Beliefs May Impede KT Referrals

Perceptions of nonadherence are a key issue

BY NATASHA PERSAUD

KDIGO GUIDELINES advise health care providers to refer patients on dialysis with past nonadherence to transplant centers for evaluation as possible kidney transplant candidates, yet not all qualified patients are referred, investigators reported at the 2023 American Transplant Congress in San Diego.

In some cases, providers delay referral or opt not to refer based on their idiosyncratic and subjective beliefs about patients’ nonadherence.

“We believe most providers at dialysis centers and at transplant centers want all eligible patients referred for kidney transplantation,” said lead investigator Jenny McDonnell, PhD/MPH candidate, of Emory University’s Rollins School of Public Health in Atlanta, Georgia, who conducted the study with senior author Adam S. Wilk, PhD, and other collaborator. “The problem is that there is no clear or universal understanding of what ‘eligible’ means in this context.”

To better understand how providers respond to patient nonadherence and make transplant referral decisions, she and her team conducted a qualitative study including 39 in-depth