Böbrek Nakli Adaylarinin Organ Teklif Listesinden Dışlanma Nedenlerinin Belirlenmesi

Öz

Amaç: Çalışmamız böbrek nakli adaylarının teklif listesinden dışlanma nedenlerini tespit etmek için planlanmıştır. Materyal ve Metot: Çalışmamız retrospektif arşiv taraması şeklinde yapılmıştır. Örneklem kriterlerine uyan 228 adayın dosyası çalışmaya dahil edilmiştir. Adayların sosyo-demografik özellikleri, kan grubu, diyaliz türü ve zamanı, panel reaktif antikorlar (PRA) sonuçları, organ bekleme süresi, alıcının güncel durumu (aktif bekleme listesinde, nakil olan ve yaşamını kaybeden) bilgileri elde edilmiştir. Bulgular: Organ teklif listesinden dışlanan adayların %14,9’una sistemde kayıtlı olan telefon numarasından ulaşılamadığı, %6,1’inin ulaşım sorunları nedeni ile merkeze gelemediği saptanmıştır. Bekleme süresi ile yaş aralığı, diyalize girme süresi, adayın güncel durumu arasında istatistiksel olarak anlamlı farklılık saptanmıştır (p<0,05). Sonuç: Hemşireler diyaliz, nakil merkezleri ve İl Sağlık Müdürlükleri ile iş birliği yaparak adayların iletişim numaralarını güncelleyebilir, ulaşım sorunlarına çözüm bulabilir, diyaliz tedavisi alan adayların vakit kaybetmeden bekleme listesine alınmasına olanak sağlayabilir.

Anahtar Kelimeler

• Böbrek nakli
• hemşirelik bakımı
• organ bekleme listesi

Determination of Reasons for the Exclusion of Kidney Transplant Candidates from the Organ Offer List

Abstract

Objective: The study aims to determine why kidney transplantation candidates are excluded from the organ offer list. Materials and Methods: The study was conducted as a retrospective screening of archived records. The data of 228 patients who met the study criteria were included. Evaluations were made concerning sociodemographic characteristics, blood group, dialysis type and time, panel reactive antibody results, duration of waiting for an organ, and the recipient's current status (on the active waiting list, transplanted, or deceased). Results: Of the candidates on the organ transplantation waiting list, 14.9% could not be contacted at the telephone number in the records, and 6.1% could not attend the centre because of transport problems. A statistically significant difference was determined between the age range, the time since starting dialysis, and the candidate's current status according to the waiting duration. Conclusion: Through collaboration with dialysis and transplantation centres and the Regional Health Authority, nurses can update the contact telephone numbers and resolve transplant candidates' transport problems, thereby allowing those receiving dialysis treatment to be added to the organ transplantation waiting list without losing time.

Keywords

• Kidney transplantation
• nursing care
• organ waiting list

Kaynakça

1. 1. Öden TN, Demir Korkmaz F. Kadavra donörden organ nakli oranlarini arttirmada hemşirenin sorumluklari: Sahada neler yapabiliriz? Celal Bayar Üniversitesi Sağlık Bilimleri Enstitüsü Dergisi. 2021;8(3):558-565. doi:10.34087/cbusbed.889801
2. 2. ORGANKDS. Organ nakli bekleyen hastalar 2022. https://organkds.saglik.gov.tr/DSS/PUBLIC/PublicDefault2.aspx#, 2022. Accessed March 3, 2022.
3. 3. Resmi Gazete. Organ Nakli Hizmetleri Yönetmeliği, 2022. https://www.resmigazete.gov.tr/eskiler/2022/12/20221209-3.htm . Accessed March 13, 2022.
4. 4. Reddy V, da Graca B, Martinez E, et al. Single-center analysis of organ offers and workload for liver and kidney allocation. American Journal of Transplantation. 2022;22(11):2661-2667. doi:10.1111/ajt.17144
5. 5. Fritsche L, Vanrenterghem Y, Nordal KP, et al. Practice variations in the evaluation of adult candidates for cadaveric kidney transplantation. Transplantation. 2000;70(10):1492-1497. doi:10.1097/00007890-200011270-00017
6. 6. Volk ML, Goodrich N, Lai JC, Sonnenday C, Shedden K. Decision support for organ offers in liver transplantation. Liver Transplantation. 2015;21:784-791. doi:10.1002/lt
7. 7. Soylu D, Tuna A. Kadavra organ nakli süreçlerinde hemşirelik bakimi. Turkiye Klinikleri J Intern Med. 2019;5(2):62-69. doi:10.5336/intermed.2019-70537
8. 8. Holley JL, Monaghan J, Byer B, Bronsther O. An examination of the renal transplant evaluation process focusing on cost and the reasons for patient exclusion. American Journal of Kidney Diseases. 1998;32(4):567-574. doi:10.1016/S0272-6386(98)70018-6

9. 9. Oruç A, Ersoy A, Ayar Y, Akgür S, Yildiz A. Exclusion reasons of cadaveric kidney transplantation candidates. Turkish Nephrology, Dialysis and Transplantation Journal. 2018;27(1):82-86. doi:10.5262/tndt.2017.1003.26
10. 10. Stewart DE, Wilk AR, Toll AE, et al. Measuring and monitoring equity in access to deceased donor kidney transplantation. American Journal of Transplantation. 2018;18(8):1924-1935. doi:10.1111/ajt.14922
11. 11. Husain SA, King KL, Pastan S, et al. Association between declined offers of deceased donor kidney allograft and outcomes in kidney transplant candidates. JAMA Network Open. 2019;2(8):1-18. doi:10.1001/jamanetworkopen.2019.10312
12. 12. T.C. Sağlık Bakanlığı. Ulusal Organ ve Doku Nakli Koordinasyon Sistemi Yönergesi 2008. https://www.saglik.gov.tr/arama?_Dil=1&p=Ulusal%20Organ%20ve%20Doku%20Nakli%20Koordinasyon%20Sistemi%20Y%C3%B6nergesi. Accessed January 10, 2021.
13. 13. King KL, Ali Husain S, Schold JD, et al. Major variation across local transplant centers in probability of kidney transplant for wait-listed patients. Journal of the American Society of Nephrology. 2020;31(12):2900-2911. doi:10.1681/ASN.2020030335
14. 14. Wallace D, Robb M, Hughes W, et al. Outcomes of patients suspended from the national kidney transplant waiting list in the United Kingdom between 2000 and 2010. Transplantation. 2020;104(8):1654-1661. doi:10.1097/TP.0000000000003033
15. 15. Lai JC, Feng S, Roberts JP. An examination of liver offers to candidates on the liver transplant wait-list. Gastroenterology. 2012;143(5):1261-1265. doi:10.1053/j.gastro.2012.07.105
16. 16. Bostock IC, Alberú J, Arvizu A, et al. Probability of deceased donor kidney transplantation based on % PRA. Transplant Immunology. 2013;28(4):154-158. doi:10.1016/j.trim.2013.05.002
17. 17. Puttarajappa CM, Tevar AD, Hoffman W, et al. Virtual crossmatch for deceased donor kidney transplantation in the United States: A survey of histocompatibility lab directors and transplant surgeons. Human Immunology. 2023;84(3):214-223. doi:10.1016/j.humimm.2022.12.001
18. 18. Sharma A, Verma S, Mirzai S, et al. Implementing a self-reported immunosuppression adherence questionnaire to screen for non-adherence in routine care of kidney transplant recipients. Clinical Transplantation. 2023;e15157:1-24. doi:10.1111/ctr.15157
19. 19. Puttarajappa CM, Hariharan S, Zhang X, et al. Early effect of the circular model of kidney allocation in the United States. Journal of the American Society of Nephrology. 2023;34(1):26-39. doi:10.1681/ASN.2022040471
20. 20. Erikoğlu M, Çora T, Güney İ, et al. Böbrek nakli için bekleyen hastalarin HLA-A , B ve Dr tiplendirmesi. Dialysis, Transplantation and Burns. 2005;16(1):8-12.
21. 21. Sharma A, Jorgensen DR, Mehta RB, et al. The clinical impact of Anti-HLA donor specific antibody detection through first year screening on stable kidney transplant recipients. Transplant International. 2022;35(March):1-13. doi:10.3389/ti.2022.10094
22. 22. Thuluvath PJ, Hanish S, Savva Y. Waiting list mortality and transplant rates for nash cirrhosis when compared with cryptogenic, alcoholic, or AIH cirrhosis. Transplantation. 2019;103(1):113-121. doi:10.1097/TP.0000000000002355
23. 23. Sokas C, Cooper Z, Salim A, Rodrigue JR, Adler JT. Wait expectations: The impact of delisting as an outcome from the kidney transplant waitlist. Clinical Transplantation. 2021;35(5):1-11. doi:10.1111/ctr.14250