ArticleBMC geriatrics2022
Defining the ethical considerations surrounding kidney transplantation for frail and cognitively impaired patients: a Delphi study of geriatric transplant experts.
Article in BMC geriatrics, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 24 citations in OpenAlex.
- Assessing and cataloguing cognitive impairment in older potential kidney transplant patients: key recommendations from the ethical and legal issues working group of ELPAT.Transplant international : official journal of the European Society for Organ Transplantation · 2026Article
- Diagnosis and Management of Dementia for the Nephrology Clinician: A Review.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2025Review
- Infection Risk in Older Kidney Transplant Recipients: An Analysis in the Era of Expanded Age Limits.Transplant international : official journal of the European Society for Organ Transplantation · 2025Article
- Patient Perspectives on the Use of Aging Metrics for Kidney Transplant Decision-Making.Progress in transplantation (Aliso Viejo, Calif.) · 2024Article
- Medical Distrust Among Kidney Transplant Candidates.Clinical transplantation · 2024Article
- Frailty and depressive symptoms in older kidney transplant recipients: opportunities for collaboration between transplant nephrologists and geriatricians.BMC geriatrics · 2024Article
- Cognitive decline related to chronic kidney disease as an exclusion factor from kidney transplantation: results from an international survey.Clinical kidney journal · 2024Article
- Use of LCP-Tacrolimus (LCPT) in Kidney Transplantation: A Delphi Consensus Survey of Expert Clinicians.Annals of transplantation · 2024Article
- Comprehensive geriatric assessment predicts listing for kidney transplant in patients with end-stage renal disease: a retrospective cohort study.BMC geriatrics · 2024Article
- Kidney Transplant Outcomes in Elderly Population: A Systematic Review and Meta-analysis.European urology open science · 2023Review
- Frailty assessment as part of transplant listing: yes, no or maybe?Clinical kidney journal · 2023Review
Corrections and comments
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Authors and funding
8 authors at 5 institutions in 1 country.
Funding
Abstract
backgroundAmong adult kidney transplant (KT) candidates, 21% are frail and 55% have cognitive impairment, increasing the risk of pre- and post-KT mortality. Centers often assess frailty status and cognitive function during transplant evaluation to help identify appropriate candidate. Yet, there are no ethical guidelines regarding the use of frailty and cognitive function during this evaluation. We seek to develop a clinical consensus on balancing utility and justice in access to KT for frail and cognitively impaired patients.
methodsTwenty-seven experts caring for ESRD patients completed a two-round Delphi panel designed to facilitate consensus (> 80% agreement).
resultsExperts believed that denying patients transplantation based solely on expected patient survival was inequitable to frail or cognitively impaired candidates; 100% agreed that frailty and cognitive impairment are important factors to consider during KT evaluation. There was consensus that health related quality of life and social support are important to consider before waitlisting frail or cognitively impaired patients. Experts identified important factors to consider before waitlisting frail (likely to benefit from KT, frailty reversibility, age, and medical contraindications) and cognitively impaired (degree of impairment and medication adherence) patients.
conclusionsClinical experts believed it was ethically unacceptable to allocate organs solely based on patients' expected survival; frailty and cognitive impairment should be measured at evaluation when weighed against other clinical factors. Ethical guidelines regarding the use of frailty and cognitive function during KT evaluation ought to be developed.
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