Procedures and criteria for accepting the renal patient for inclusion on the waiting list for kidney transplantation in the Nordic countries.

BACKGROUND: The overall aim of this study was to survey and analyze the selection process for patients awaiting a kidney in the Nordic countries collaborating within Scandiatransplant. METHODS: A two-parts questionnaire was sent to one senior physician at each of the 10 Scandiatransplant kidney transplantation centers that use deceased donors. The first part consisted of questions related to the evaluation of a patient for the waiting list. The second part of the questionnaire dealt with 12 borderline cases, based on experiences at seven of all centers. Answers should be given with the policy of the center in mind. The response rate was 100%. RESULTS: Some centers are stricter than others regarding limits for body mass index and cardiac ejection fraction. At three centers, human immunodeficiency virus-positive patients are not included on the list. Four centers have a policy of not including predialysis patients. All centers agreed that they would not refrain from acceptance of a patient due to the scarcity of organs, if the patient was considered to benefit medically from transplantation. Reevaluation of the patient once on the list is done at all centers, focusing on cardiovascular problems. Only a few respondents were positive to the idea of common Nordic guidelines for investigations or for limiting values. CONCLUSIONS: We concluded that there are some, mainly small, differences among Nordic countries regarding procedures and criteria for acceptance of patients on the waiting list for kidney transplantation. The interest in common guidelines is limited.

Attitudes toward xenotransplantation--patients waiting for transplantation versus the general public.

The aim of this study was to survey attitudes toward xenotransplantation and to investigate whether there is a difference in attitudes between patients awaiting a kidney transplantation and the general public. A questionnaire was sent to randomly selected members of the public aged 18-75 (n = 1000) and to all patients of the same age group waiting for kidney transplants in Sweden in 1998 (n = 460). Among the public, 60 % expressed a positive attitude toward receiving an animal kidney graft with the same degree of risk as a human kidney graft, compared with 66 % for the patients. The proportion in favour of receiving a heart remained 60 % for the public, but rose to 70 % for the patients. If a human heart was not available, 61 % of the public were for the use of an animal heart, compared with 73 % in the patient group. A majority of the respondents would accept a transplant from an animal, provided the result and risk of infection were the same as with a human transplant. A greater proportion of patients had a positive attitude to receiving a xenotransplant than did the general public. A life threatening situation marginally increased the positive proportions.

Attitudes towards organ donation and transplantation--a study involving Baltic physicians.

The aim of this study was to identify and describe attitudes towards organ donation and transplantation among a group of Baltic physicians who are involved in this aspect of medical care. A total of 151 neurosurgeons, anesthesiologists, and neurologists anonymously answered a questionnaire between February and March 1995. The majority of physicians said they would be willing to donate their own organs after their death but disagreed with the idea of using organs from a dead person who had had a negative opinion towards organ donation. Given a patient who fulfilled the criteria for brain death, this group of physicians found it widely acceptable to keep the patient on a ventilator until organ donation could take place. We conclude that the participating physicians generally have similar attitudes towards organ donation and transplantation. This study is valuable in that it shows the interest in, and the need for, clinical and research collaboration, including a discussion of ethics, within the area of organ donation and transplantation. This is essential for future collaboration with Western countries.