A recent study shows that transplant centres that have low scores on performance evaluations are more likely to remove more patients from the transplant waiting list. The study is published in the American Journal of Transplantation.
Data from the U.S. Scientific Registry of Transplant Recipients on 315,796 candidates on the kidney transplant waiting list from 2007 to 2014 shows that the rate of removal was 60 percent higher for centres with low performance evaluation scores as compared to other centres. This was true irrespective of the demographic characteristics and clinical characteristics of the transplant candidates. There was a significant decline in transplant rates following low scores and deaths rates were also significantly lower amongst candidates removed at these centres. This indicates that those patients who were removed were relatively healthier.
These findings suggest that greater scrutiny of transplant centre performance could result in reduced access to transplantation for the sickest and most complex cases because as they receive low scores, such centres become more conservative in their waiting list.
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"These findings must be placed in perspective that numerous studies verify that the survival benefit of kidney transplantation extends to patients with multiple risk factors and with use of relatively higher risk donor organs. Thus, any policies that may stifle the growth of transplantation should be carefully examined," said Dr. Jesse Schold, lead author of the study. "At the same time, transplant centers must be vigilant that their processes of care are based on best clinical judgement and available empirical evidence and not irrationally influenced by regulatory oversight. Ultimately, as a field, we must critically assess whether we can align policies and care practices to best treat patients and provide transplant opportunities for recipients and donor families."
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