Why hemodialysis patients fail to complete the transplantation process

The cadaveric renal transplantation process involves steps related to medic al suitability, interest in transplantation, pretransplantation workup, and movement up a waiting list. Failure to complete specific steps may be caus ed by remaining stationary at that step, moving backward to a previous step , or dying, Knowing the relative importance of these types of movement may enable the development of strategies that improve the efficiency and equity of the transplantation process. We examined 4,597 new dialysis patients to determine the likelihood of remaining stationary, moving backward, or dyin g at each of the following steps: (4) being medically suitable and possibly interested in transplantation, (B) being definitely interested, (C) comple ting the pretransplantation workup, and (D) moving up a waiting list and re ceiving a transplant. Failure to complete a step was generally caused by re maining stationary rather than moving backward or dying. The likelihood of remaining stationary ranged from 78% at step A to 90% at step D. The likeli hood of backward movement ranged from 3% to 7%, whereas the likelihood of d eath ranged from 7% to 22%. Compared with whites, blacks were more likely t o remain stationary at steps A (odds ratio [OR], 1.96) and B (OR, 1.52), mo re likely to move backward at step B (OR, 1.79), and less likely to die at steps A through C (ORs, 0.45 to 0.60). In conclusion, failure to move throu gh the transplantation process is usually caused by remaining stationary at specific steps rather than moving backward or dying. The relative importan ce of these types of movement differs among blacks and whites. (C) 2001 by the National Kidney Foundation, Inc.