Attitudes of minority patients with end-stage renal disease regarding ABO-incompatible list-paired exchanges

Abstract

A few transplant centers in the United States have implemented list-paired exchange programs that include both ABO-compatible and ABO-incompatible living-donor recipients. ABO-incompatible list-paired exchanges raise ethical concerns because they increase the total number of organs available but increase the waiting time for wait-list candidates of blood type O. In this manuscript, we explore attitudes of a convenience sample of minority patients with end-stage renal disease (ESRD) regarding living paired exchanges, ABO-compatible and ABO-incompatible list-paired exchanges and ABO-incompatible direct transplants. Data from 87 minority respondents were analyzed. Eighty-seven (100%) supported living paired exchanges and ABO-compatible list-paired exchanges. In contrast, only 50 of 85 (59%) respondents supported ABO-incompatible list-paired exchanges (p < 0.001), including half (12 of 24) of those with blood type O. Subjects were asked how much additional time it would be fair to ask wait-list candidates of blood type O to wait to implement ABO-incompatible list-paired exchanges. Forty percent (35 of 87) responded 'no additional time' and another 10% (9 of 87) responded 'one month or shorter'. Minority dialysis patients hold mixed opinions about the fairness of ABO-incompatible list-paired exchanges. If our findings are confirmed in a more diverse randomly selected sample, then the UNOS variances that permit these exchanges should be reconsidered.