Canadian transplant nephrologists' perspectives on the decision-making process for accepting or refusing a kidney from a deceased organ donor

Background Kidney transplantation is the best treatment for patients with end-stage renal disease. The decision to accept a kidney from a deceased donor can be a difficult one, especially when organs from high KDPI (>85%) donors are offered. This study aims to capture the perspectives of transplant nephrologists (TNs) on the decision-making process when an organ is offered. Methods Fifteen Canadian TNs took part in semi-structured interviews between December 2017 and April 2018. The interviews were digitally recorded, transcribed, and analyzed using the thematic analysis method. Results The decision to accept a deceased-donor kidney offer is a medical one for the participants. However, transplant candidates could be involved when the offered kidney is from a donor with a KDPI >85% or increased infectious risk donor. The TNs' past experience, comprehensive data on the donor, and education of the transplant candidate could facilitate the decision-making process. A decision aid could also facilitate the decision-making process, but different concerns should be addressed. Conclusion Although accepting a deceased-donor organ offer is often viewed as an opportunity for shared decision-making, participants in this study viewed the decision to accept or refuse an offer as a medical decision with little room for patient participation.