PMID- 37296384 OWN - NLM STAT- MEDLINE DCOM- 20230612 LR - 20231121 IS - 1471-2369 (Electronic) IS - 1471-2369 (Linking) VI - 24 IP - 1 DP - 2023 Jun 9 TI - Adding epitope compatibility to deceased donor kidney allocation criteria: recommendations from a pan-Canadian online public deliberation. PG - 165 LID - 10.1186/s12882-023-03224-z [doi] LID - 165 AB - BACKGROUND: The widening supply-demand imbalance for kidneys necessitates finding ways to reduce rejection and improve transplant outcomes. Human leukocyte antigen (HLA) epitope compatibility between donor and recipient may minimize premature graft loss and prolong survival, but incorporating this strategy to deceased donor allocation criteria prioritizes transplant outcomes over wait times. An online public deliberation was held to identify acceptable trade-offs when implementing epitope compatibility to guide Canadian policymakers and health professionals in deciding how best to allocate kidneys fairly. METHODS: Invitations were mailed to 35,000 randomly-selected Canadian households, with over-sampling of rural/remote locations. Participants were selected for socio-demographic diversity and geographic representation. Five two-hour online sessions were held from November-December 2021. Participants received an information booklet and heard from expert speakers prior to deliberating on how to fairly implement epitope compatibility for transplant candidates and governance issues. Participants collectively generated and voted on recommendations. In the final session, kidney donation and allocation policymakers engaged with participants. Sessions were recorded and transcribed. RESULTS: Thirty-two individuals participated and generated nine recommendations. There was consensus on adding epitope compatibility to the existing deceased donor kidney allocation criteria. However, participants recommended including safeguards/flexibility around this (e.g., mitigating declining health). They called for a transition period to epitope compatibility, including an ongoing comprehensive public education program. Participants unanimously recommended regular monitoring and public sharing of epitope-based transplant outcomes. CONCLUSIONS: Participants supported adding epitope compatibility to kidney allocation criteria, but advised safeguards and flexibility around implementation. These recommendations provide guidance to policymakers about incorporating epitope-based deceased donor allocation criteria. CI - (c) 2023. The Author(s). FAU - Edwards, Louisa AU - Edwards L AUID- ORCID: 0000-0001-9371-2805 AD - School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada. louisa.edwards@ubc.ca. AD - Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada. louisa.edwards@ubc.ca. FAU - Bentley, Colene AU - Bentley C AD - BC Cancer, Vancouver, Canada. FAU - Burgess, Michael AU - Burgess M AD - School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada. AD - W. Maurice Young Centre for Applied Ethics, UBC, Vancouver, Canada. FAU - Sapir-Pichhadze, Ruth AU - Sapir-Pichhadze R AD - Division of Nephrology, Department of Medicine, McGill University, Montreal, Canada. AD - Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Vancouver, Canada. FAU - Hartell, David AU - Hartell D AD - Hartell Consulting, Ottawa, Canada. FAU - Keown, Paul AU - Keown P AD - Department of Medicine, UBC, Vancouver, Canada. AD - Immune Centre of BC, Vancouver Coastal Health, Vancouver, Canada. FAU - Bryan, Stirling AU - Bryan S AD - School of Population & Public Health, University of British Columbia (UBC), 717 - 828 West 10th Avenue, Research Pavilion, Vancouver, BC, V5Z 1M9, Canada. AD - Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada. LA - eng GR - CIHR/Canada PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20230609 PL - England TA - BMC Nephrol JT - BMC nephrology JID - 100967793 RN - 0 (Epitopes) SB - IM MH - Humans MH - Epitopes MH - *Kidney Transplantation MH - Canada MH - Tissue Donors MH - Kidney MH - Graft Survival MH - *Tissue and Organ Procurement PMC - PMC10255937 COIS- The authors declare that they have no competing interests. EDAT- 2023/06/10 15:14 MHDA- 2023/06/12 06:42 PMCR- 2023/06/09 CRDT- 2023/06/09 23:32 PHST- 2022/11/10 00:00 [received] PHST- 2023/05/30 00:00 [accepted] PHST- 2023/06/12 06:42 [medline] PHST- 2023/06/10 15:14 [pubmed] PHST- 2023/06/09 23:32 [entrez] PHST- 2023/06/09 00:00 [pmc-release] AID - 10.1186/s12882-023-03224-z [pii] AID - 3224 [pii] AID - 10.1186/s12882-023-03224-z [doi] PST - epublish SO - BMC Nephrol. 2023 Jun 9;24(1):165. doi: 10.1186/s12882-023-03224-z.