Selection of patients for kidney transplantation; how scarcity of donor organs is dealt with

Objective. To investigate what criteria are applied in the actual practice of patient selection for renal transplantation and how practice relates to guidelines developed in medical ethics and health law. Setting. Two centres for renal transplantation and nine dialysis centres. Design. Descriptive. Methods. Data were collected by observation and open interviews with 33 physicians and other health professionals involved, and analysed using a computer programme for qualitative data. Results. Formally, scarcity of donor organs did not affect the referral and indication of patients for renal transplantation. However, according to some respondents, fewer people were entered on the waiting list because of scarcity. This concerned mainly patients less likely to benefit from a transplantation in terms of life expectancy or enhancement of quality of life. Conclusion. There was some 'covert selection', in that scarcity implicitly or unintentionally was a factor in the decision whether or not to place patients on the waiting list for renal transplantation. The absence of consensus on acceptable selection criteria and the emphasis on medical criteria in the social debate on selection criteria may have contributed to this covert selection.