Kidney transplant candidates’ perspectives on the implementation of a Canadian Willingness to Cross program: A strategy to increase access to kidney transplantation for highly sensitized patients

• DOI: 10.1111/ctr.15338
• Publication Date: 2024-05-19T11:54:09Z
• Authors: Aliya Affdal; Mohamad Issa; Fabian Ballesteros; Marie‐Françoise Malo; Gurvir Thind; Teresa Atkinson; Kristi Coldwell; Kuljit Grewal; KaYee Wong; James H. Lan; Marie‐Chantal Fortin
• Keywords: Male; Adult; Graft Rejection; Canada; Tissue and Organ Procurement; Waiting Lists; Graft Survival; Middle Aged; Prognosis; Kidney Transplantation; Health Services Accessibility; Tissue Donors; 03 medical and health sciences; 0302 clinical medicine; Isoantibodies; Humans; Kidney Failure, Chronic; Female; Follow-Up Studies; Aged

AbstractBackgroundKidney transplantation is the optimal treatment for end‐stage renal disease. However, highly sensitized patients (HSPs) have reduced access to transplantation, leading to increased morbidity and mortality on the waiting list. The Canadian Willingness to Cross (WTC) program proposes allowing transplantation across preformed donor specific antibodies (DSA) determined to be at a low risk of rejection under the adaptive design framework. This study collected patients’ perspectives on the development of this program.MethodsForty‐one individual interviews were conducted with kidney transplant candidates from three Canadian transplant centers in 2022. The interviews were digitally recorded and transcribed for subsequent analyses.ResultsDespite limited familiarity with the adaptive design, participants demonstrated trust in the researchers. They perceived the WTC program as a pathway for HSPs to access transplantation while mitigating transplant‐related risks. HSPs saw the WTC program as a source of hope and an opportunity to leave dialysis, despite acknowledging inherent uncertainties. Some non‐HSPs expressed concerns about fairness, anticipating increased waiting times and potential compromise in kidney graft longevity due to higher rejection risks. Participants recommended essential strategies for implementing the WTC program, including organizing informational meetings and highlighting the necessity for psychosocial support.ConclusionThe WTC program emerges as a promising strategy to enhance HSPs’ access to kidney transplantation. While HSPs perceived this program as a source of hope, non‐HSPs voiced concerns about distributive justice issues. These results will help develop a WTC program that is ethically sound for transplant candidates.