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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.

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.

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.

Purpose – To present detailed examples of the social construction of understandings, exploring interplay between social and individual sense making.

Methodology/approach – A form of ethnomethodological discourse analysis is undertaken using text from online discussions groups for people with kidney failure. Sense making is theorised using Dervin's Sense-Making Methodology (1999) as a starting point. Chatman's Theory of Normative Behaviour (2000) and Pettigrew's Information Grounds (1999) are considered for their potential to theorise social impacts on individual understandings, while a practice theoretic approach (Gherardi, 2009a, 2009b) illuminates dynamics between social and individual sense making.

Findings – Local understandings developed out of repetition with gradual modification of ideas. Meanwhile, generic information such as facts was usually contextualised by descriptions of lived experiences. In this way, specifics were emphasised rather than generalities. However, the detailed, non-prescriptive commentaries provided by individuals gathered into usefully loose (non-specific) fields of possibilities.

Research implications – Information and knowledge manifest as transient and customised. This suggests a need for caution if researchers conceive people as having stable ‘knowledge structures’ which can be mapped by research, and it raises questions about durable incarnations of information.

Practical implications – People must produce flexible understandings particular to their situation. This requires time, reiteration and access to contributions from a range of sources. Provision of generic information during one-off interactions is only a first step towards support of these larger needs.

Originality/value of paper – Extends relational conceptions of information and verb-based metaphors for sense making, by proposing sense making, information and knowledge as transient and customised.

Objective – To present the challenges arising from the double burden of disease in developing countries, focusing on the case of Mexico, and to propose a strategy for addressing these challenges.

Methodology/approach – Mortality and morbidity data are presented for selected countries and groups of diseases. Specific examples of the pressures faced by the public health services in Mexico to provide and finance treatment for communicable and non-communicable diseases are used to illustrate the extent of the challenges in the context of a country with limited resources.

Findings – Public health systems in developing countries face strong pressure to provide and finance treatment for both communicable and non-communicable diseases, inevitably producing competition among diseases and conditions and requiring trade-offs between equity and efficiency goals.

Implications for policy – In developing countries, addressing the challenges presented by the double burden of disease requires a multidisciplinary approach to develop and strengthen the policymaking process. This involves the use of analytical tools applied to each stage of the planning cycle, in particular the use of an explicit priority setting process together with monitoring and assessment to strengthen decision making under limited resources.

While certain contested goods do manage to make their way to market, others have moved less far in this direction and others seem permanently unable to do so. Moral contestation promotes, holds back or blocks the emergence of contested markets. This chapter examines the conditions that make the operation of these markets possible, and those that block their appearance. From a comparison between two cases (organs for transplantation and gambling), the authors focus attention on the one hand on those devices that make transactions possible, and on the other, on the “vulnerable populations” that these devices are intended to protect, either from or by the market.