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Disparities in transplant rates across social categories provide limited information about gatekeeping processes in access to kidney transplantation. We hypothesized that early opportunities for discussion of kidney transplantation potentially generate social capital that serves as a resource for patients as they navigate the transplantation pathway.

A national sample of first-year dialysis patients was surveyed and asked if kidney transplantation had been discussed with them before and after starting dialysis treatment. Associations between reported discussion and patient-specific clinical and nonclinical (sociodemographic) indicators of attributed utility for transplantation were investigated, and the association of reported transplant discussion with subsequent transplant waitlisting was analyzed.

Time to placement on the kidney transplant waiting list was significantly shorter for patients who reported that transplantation had been discussed with them before, as well as after, starting dialysis. Likelihood of reported discussion varied by patient age, employment and insurance status, cardiovascular comorbidity burden, and perceived health status; in addition, women were less likely to report early discussion.

It would be valuable to know more about the nature of the transplant discussions recalled by patients to better understand how social capital may be fostered through these discussions.

Indicators of attributed utility for successful transplantation were associated with transplant discussion both before and after starting dialysis, potentially contributing to observed disparities in access to kidney transplantation.

Predialysis nephrology care and patient participation in discussion of kidney transplantation may foster social capital that facilitates navigating the transplantation pathway.

There is a significant body of literature explaining how a free market for kidneys would eliminate both the economic and the medical shortage of kidneys and thus, in addition to supplying sufficient kidneys for those who become needy in the future, remove the entire backlog of 40,000+ patients waiting for a kidney transplant in the United States. This article is an attempt to fathom the financial and market processes that would evolve were a free market for kidneys to be permitted. Issues addressed include the types of institutions that would likely develop, how transactions would be facilitated, and what would happen to the price of kidneys both in the short and long term.

This study examined dimensions of young-adulthood development in lived experience reported by young persons (19 women, 18 men) with the disabling condition of kidney failure requiring chronic dialysis or kidney transplantation. In semistructured phone interviews, participants (ages 23–37) described their family/living situation, employment and community activity, current situation, and experience. Participants' qualitative responses about “the way you see things, do things, feel about things” and “how you feel about yourself” were examined to identify themes. Limited achievement of proposed “successful” dimensions of young adulthood characterized the study cohort, based on indicators included in the interview. In qualitative data, the theme of perceived stigma and spoiled identity (Goffman, 1963) was reflected in comments offered by participants regarding their self-confidence and motivation to pursue goals. A second theme in participants' qualitative responses was a sense of isolation from age peers who shared their condition, and participants expressed frustration around having an age-inappropriate condition (“why me?”). Perceived stigma and spoiled identity impact social ties and life goals and are understudied influences in the life course trajectory of young persons with kidney failure and the challenges inherent in navigating health status and developmental life course transitions.

Dr. Juan Caicedo was educated in general medicine and surgery at Universidad Nacional de Colombia and practiced transplant medicine in Bogota. He determined that he would need to go to the United States to advance his training, and ultimately was awarded a fellowship in transplant surgery at Northwestern Memorial Hospital.

During his three years as a fellow, Caicedo was struck by the number of Hispanic patients on the kidney transplant waiting list. Not only were Hispanics the highest growth group on the transplant waiting list, they also waited longer for transplants and died while waiting at higher rates than non-Hispanic whites or African-Americans. Caicedo also was alarmed by Hispanic patients' lower utilization of living donors for transplantation they were underrepresented not only as live donor transplant patients, but also as donors.

As he neared the end of his fellowship in 2006, Caicedo wondered if the Hispanic population encountered unique barriers to transplantation and living donor usage, and began to think about creating a program to address these barriers.

The purpose of this study was to identify factors that affect willingness to donate kidneys posthumously among Malaysians.

A questionnaire-based cross-sectional study assessing demographics, attitude, spirituality, knowledge and willingness to donate a kidney was conducted among adult Malaysians with oral informed consent. The total number of samples was 1,001 respondents. Univariate and multivariate logistic regression was performed.

A total of 29.17% (n = 292) were willing to donate kidneys, while the remaining 70.83% (n = 709) were not. The mean spirituality score was 80.95 ± 13.79 (maximum score 100), mean attitude score was 52.88 ± 8.074 (maximum score 70) and mean knowledge score was 1.84 ± 0.99 (maximum score 5). A higher score demonstrated a stronger spiritual level, positive attitude and better knowledge. Factors affecting willingness to donate a kidney were ethnicity (odds ratio [OR] = 15.625, 95% confidence interval [CI] = 0.043–0.094) and attitude toward kidney donation score (OR = 0.924, 95% CI = 0.902–0.945).

Culture-specific steps to improve programs that may contribute toward improving kidney donation posthumously among Malaysians should be developed. Results drawn from this work demonstrate that policymakers, health-care workers and stakeholders should work together to promote effective policies and program implementation to reduce the ever-increasing gap between the need and shortage crisis of kidney donation.

Strong evidence exists that compliance with the treatment regimen is a major problem for many transplant patients. Noncompliance with the treatment regimen is particularly evident among kidney‐transplanted adolescents. Research has not examined the adolescents' experience of living with a kidney transplant. Provides a review of the literature seeking to explain the causes of noncompliance in the population group. Although the studies referred to here provide insights into the situation, many lack reliability and validity because of methodological limitations. They also point to a gap in understanding the condition from the point of view of the adolescent. A more useful approach, therefore, is to use a qualitative research methodology. Such an approach has been shown to be useful in a study of diabetic adolescents, and offers promise for the greater understanding of kidney‐transplanted adolescents and the impact the medical regimen has on them. With improved understanding comes the ability of health practitioners to better meet their needs in terms of improving the quality of their post‐operative lives.

The paper is targeted to health service management teams as an aid to understanding the relationship between investment in process redesign in a clinical laboratory environment and improved quality of service/increased clinical activity.

An audit of the unit's serum screening capability was performed against the standards of the current UK allocation scheme for cadaveric kidneys. Based on findings of this audit the laboratory's serum screening protocol was redesigned involving development of a new testing strategy and introduction of novel methods. A concurrent review of the effects of this initiative in terms of cadaveric kidney offers received/transplant numbers was undertaken and a cost‐benefit analysis made.

An improved eligibility of the patient cohort for cadaveric kidney offers was obtained together with a reduced unexpected positive crossmatch rate. These factors have together contributed to an increase in transplant numbers at the centre. Significant cost benefits have been achieved

The relevance of the findings relating to patient eligibility for available cadaveric grafts is limited to organ‐sharing schemes in which recipient sensitisation is considered as part of the allocation process.

The experience reported demonstrates the necessity of assessing the clinical impact of changes in practice when judgements are being made regarding the costs of laboratory services. In this respect the paper is the first from within this discipline to make this association.

Kidney transplantation (KT) is the treatment of choice for end-stage chronic kidney disease (CKD) and is well known to improve the clinical outcome of patients. However, the impact of KT on comorbid psychological symptoms, particularly depression and anxiety, is less clear, and recipients of living-donor (LD) organs may have a different psychological outcome from recipients of dead-donor (DD) organs.

In total, 152 patients were included and analyzed using a cross-sectional design. Of these patients, 25 were pre-KT, 13 were post-KT with a LD transplant and 114 were post-KT with a DD transplant. The patients were tested for a variety of psychometric outcomes using the Hospital Anxiety and Depression Scale, the 12-Item Short Form Health Survey (assessing physical and mental health-related quality of life), the Resilience Scale, the Coping Self-Questionnaire and the Social Support Questionnaire.

The mean age of the patients was 51.25 years and 40 per cent of the patients were female. As expected, the post-KT patients had significantly better scores on the physical component of the Short Form Health Survey than the pre-KT patients, and there were no significant differences between the two post-KT groups. There were no significant differences among the groups in any of the other psychometric outcome parameters tested, including anxiety, depression and the mental component of health-related quality of life.

KT and the origin of the donor organ do not appear to have a significant impact on the psychological well-being of transplant patients with CKD. Although the diagnosis and early treatment of psychological symptoms, such as depression and anxiety, remain important for these patients, decisions regarding KT, including the mode of transplantation, should not be fundamentally influenced by concerns about psychological impairments at the population level.

CKD is a serious condition involving profound impairment of the physical and psychological well-being of patients. KT is considered the treatment of choice for most of these patients. KT has notable advantages over dialysis with regard to the long-term physical functioning of the renal and cardiovascular system and increases the life expectancy of patients. However, the data on the improvement of psychological impairments after KT are less conclusive.

This study aims to develop a hierarchical model that uncovers the relationships between challenges confronting Africa's organ transplant supply chain systems.

Eleven challenges (variables) were identified after a comprehensive review of the existing literature. The contextual interactions among these variables were analysed from the perspectives of health-care stakeholders in two sub-Saharan Africa (SSA) countries (Nigeria and Uganda), using Delphi-interpretive structural modelling-cross-impact matrix multiplication applied to classification (MICMAC) techniques.

The findings reveal that weak regulatory frameworks, insufficient information systems and a lack of necessary skills make it challenging for critical actors to perform the tasks effectively. The interaction effects of these challenges weaken organ supply chains and make it less efficient, giving rise to negative externalities such as black markets for donated organs and organ tourism/trafficking.

This paper establishes a solid foundation for a critical topic that could significantly impact human health and life once the government or non-profit ecosystem matures. The MICMAC analysis in this paper provides a methodological approach for future studies wishing to further develop the organ supply chain structural models.

The study provides valuable insights for experts and policymakers on where to prioritise efforts in designing interventions to strengthen organ transplantation supply chains in developing countries.

This study is one of the first to empirically examine the challenges of organ transplant supply chains from an SSA perspective, including theoretically grounded explanations from data collected in two developing countries.

The research analyzes good practices in health care “management experimentation models,” which fall within the broader range of the integrative public–private partnerships (PPPs). Introduced by the Italian National Healthcare System in 1991, the “management experimentation models” are based on a public governance system mixed with a private management approach, a patient-centric orientation, a shared financial risk, and payment mechanisms correlated with clinical outcomes, quality, and cost-savings. This model makes public hospitals more competitive and efficient without affecting the principles of universal coverage, solidarity, and equity of access, but requires higher financial responsibility for managers and more flexibility in operations.

In Italy the experience of such experimental models is limited but successful. The study adopts the case study methodology and refers to the international collaboration started in 1997 between two Italian hospitals and the University of Pittsburgh Medical Center (UPMC – Pennsylvania, USA) in the field of organ transplants and biomedical advanced therapies.

The research allows identifying what constitutes good management practices and factors associated with higher clinical performance. Thus, it allows to understand whether and how the management experimentation model can be implemented on a broader basis, both nationwide and internationally. However, the implementation of integrative PPPs requires strategic, cultural, and managerial changes in the way in which a hospital operates; these transformations are not always sustainable.

The recognition of ISMETT’s good management practices is useful for competitive benchmarking among hospitals specialized in organ transplants and for its insights on the strategies concerning the governance reorganization in the hospital setting. Findings can be used in the future for analyzing the cross-country differences in productivity among well-managed public hospitals.