Dataset Information

Defining the ethical considerations surrounding kidney transplantation for frail and cognitively impaired patients: a Delphi study of geriatric transplant experts.

ABSTRACT:

Background

Among 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.

Methods

Twenty-seven experts caring for ESRD patients completed a two-round Delphi panel designed to facilitate consensus (> 80% agreement).

Results

Experts 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.

Conclusions

Clinical 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.

SUBMITTER: Shrestha P

PROVIDER: S-EPMC9264705 | biostudies-literature | 2022 Jul

REPOSITORIES: biostudies-literature

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Publications

Defining the ethical considerations surrounding kidney transplantation for frail and cognitively impaired patients: a Delphi study of geriatric transplant experts.

Shrestha Prakriti P Van Pilsum Rasmussen Sarah E SE King Elizabeth A EA Gordon Elisa J EJ Faden Ruth R RR Segev Dorry L DL Humbyrd Casey Jo CJ McAdams-DeMarco Mara M

BMC geriatrics 20220708 1

<h4>Background</h4>Among 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 ...[more]

PMID: 35804289

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Project description:BackgroundEuropean Member States, the European Commission and its agencies work together to enhance preparedness and response for serious cross-border threats to health such as Ebola. Yet, common understanding of public health emergency preparedness across EU/EEA countries is challenging, because preparedness is a relatively new field of activity and is inherently fraught with uncertainty. A set of practical, widely accepted and easy to use recommendations for generic preparedness that bundles the activities described in separate guidance documents supports countries in preparing for any possible health threat. The aim of this consensus procedure was to identify and seek consensus from national-level preparedness experts from EU/EEA countries on key recommendations of public health emergency preparedness.MethodsTo identify key recommendations and to prioritize the recommendations we started with a literature consensus procedure, followed by a modified Delphi method for consultation of public health emergency preparedness leaders of EU/EEA countries. This consisted of six consecutive steps: a questionnaire to achieve consensus on a core set of recommendations, a face-to-face consultation, preselection of prioritized recommendations, a questionnaire to achieve consensus on the prioritized set and a face-to-face consensus meeting to further prioritize recommendations.ResultsAs a result, EU/EEA experts selected 149 recommendations as core preparedness principles and prioritized 42. The recommendations were grouped in the seven domains: governance (57), capacity building and maintenance (11), surveillance (19), risk-assessment (16), risk- and crisis management (35), post-event evaluation (6) and implementation of lessons learned (5).ConclusionsThis prioritised set of consensus principles can provide a foundation for countries aiming to evaluate and improve their preparedness for public health emergencies. The recommendations are practical, support generic preparedness planning, and can be used by all countries irrespective of their current level of preparedness.

Project description:ObjectiveTo better understand diverse experts' views about the ethical implications of ongoing research funded by the National Institutes of Health that uses machine learning to predict HIV/AIDS risk in sub-Saharan Africa (SSA) based on publicly available Demographic and Health Surveys data.DesignThree rounds of semi-structured surveys in an online expert panel using a modified Delphi approach.ParticipantsExperts in informatics, African public health and HIV/AIDS and bioethics were invited to participate.MeasuresPerceived importance of or agreement about relevance of ethical issues on 5-point unipolar Likert scales. Qualitative data analysis identified emergent themes related to ethical issues and development of an ethical framework and recommendations for open-ended questions.ResultsOf the 35 invited experts, 22 participated in the online expert panel (63%). Emergent themes were the inclusion of African researchers in all aspects of study design, analysis and dissemination to identify and address local contextual issues, as well as engagement of communities. Experts focused on engagement with health and science professionals to address risks, benefits and communication of findings. Respondents prioritised the mitigation of stigma to research participants but recognised trade-offs between privacy and the need to disseminate findings to realise public health benefits. Strategies for responsible communication of results were suggested, including careful word choice in presentation of results and limited dissemination to need-to-know stakeholders such as public health planners.ConclusionExperts identified ethical issues specific to the African context and to research on sensitive, publicly available data and strategies for addressing these issues. These findings can be used to inform an ethical implementation framework with research stage-specific recommendations on how to use publicly available data for machine learning-based predictive analytics to predict HIV/AIDS risk in SSA.

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Project description:IntroductionRetrospective trauma scores are often used to categorise trauma, however, they have little utility in the prehospital or hyper-acute setting and do not define major trauma to non-specialists. This study employed a Delphi process in order to gauge degrees of consensus/disagreement amongst expert panel members to define major trauma.MethodA two round modified Delphi technique was used to explore subject-expert consensus and identify variables to define major trauma through systematically collating questionnaire responses. After initial descriptive analysis of variables, Kruskal-Wallis tests were used to determine statistically significant differences (p < 0.05) in response to the Delphi statements between professional groups. A hierarchical cluster analysis was undertaken to identify patterns of similarity/difference of response. A grounded theory approach to qualitative analysis of data allowed for potentially multiple iterations of the Delphi process to be influenced by identified themes.ResultsOf 55 expert panel members invited to participate, round 1 had 43 participants (Doctor n = 20, Paramedic n = 20, Nurse n = 5, other n = 2). No consistent patterns of opinion emerged with regards to professional group. Cluster analysis identified three patterns of similar responses and coded as trauma minimisers, the middle ground and the risk averse. Round 2 had 35 respondents with minimum change in opinion between rounds. Consensus of > 70% was achieved on many variables which included the identification of life/limb threatening injuries, deranged physiology, need for intensive care interventions and that extremes of age need special consideration. It was also acknowledged that retrospective injury severity scoring has a role to play but is not the only method of defining major trauma. Various factors had a majority of agreement/disagreement but did not meet the pre-set criteria of 70% agreement. These included the topics of burns, spinal immobilisation and whether a major trauma centre is the only place where major trauma can be managed.ConclusionBased upon the output of this Delphi study, major trauma may be defined as: "Significant injury or injuries that have potential to be life-threatening or life-changing sustained from either high energy mechanisms or low energy mechanisms in those rendered vulnerable by extremes of age".

Dataset Information

Defining the ethical considerations surrounding kidney transplantation for frail and cognitively impaired patients: a Delphi study of geriatric transplant experts.

Background

Methods

Results

Conclusions

Publications

Defining the ethical considerations surrounding kidney transplantation for frail and cognitively impaired patients: a Delphi study of geriatric transplant experts.

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