PATIENTS VIEWS IN THE CHOICE OF RENAL-TRANSPLANT

Little is known about chronic dialysis patients' reasons for electing renal transplantation. We investigated chronic dialysis patients' reas ons for choosing to be listed or not listed for renal transplantation. Chronic dialysis patients were asked to complete a questionnaire cons isting of demographic information and questions related to desire for transplantation and previous transplant experience. The mean age of th e dialysis population was 48 +/- 15 years (range 16 to 81 years); the population was 61% women, 39% African American, and 26% diabetic. The questionnaires of the 95 patients eligible for transplantation were an alyzed. Forty-four percent of the eligible patients were active on a t ransplant waiting list; 56% of patients refused transplantation. Twent y-nine percent of the surveyed patients had had at least one previous transplant. Listed patients were younger (43 vs. 52 years), had fewer years of ESRD (5 vs. 9 years), and were more likely to be on home dial ysis therapy (55% vs. 32%). There were no differences between listed a nd unlisted patients in gender, race, years of education, marital stat us? children, diabetes mellitus, and previous transplant experience. A frican American patients reporting strong religious beliefs were less likely to be listed for transplantation (76% vs. 24%); religious belie fs were not related to white patients' listing for transplantation. Th e most reported reason for electing transplantation was ''hoping for a better quality of life'' (86% of respondents). More never-transplante d patients elected transplantation ''hoping it will make me live longe r'' (69% vs. 25% with previous transplant) and because their doctor (5 0% vs. 6%) or family (42% vs. 6%) thought it was a good idea. Of patie nts who declined transplant, 92% with previous transplant experience i ndicated that the experience discouraged them from seeking retransplan tation; 59% of patients without transplant experience reported that se eing what happened to others with a failed transplant affected their d ecision nor to seek transplantation. Our findings suggest that race an d gender differences in electing transplant may disappear when all pat ients are actively solicited for transplantation. However, older patie nts may be less likely to elect transplant because they are more satis fied with life on dialysis or less willing to take risks. Further stud y of patients' reasons for electing transplantation is required before demographic variations in transplant choices can be accurately interp reted.