Document Type

DNP Project

Publication Date

8-18-2019

Abstract

Background and Review of Literature: Renal transplantation has a significant survival benefit over dialysis and is the recommended treatment modality for ESRD in the eligible HIV infected candidate. However, there are multiple disparities in accessing renal transplant among this group including restrictive selection criteria as determined by individual transplant centers. Only 20% of potentially eligible HIV infected candidates progress towards activation to the renal transplant waiting list in comparison to 73% of their non-HIV infected counterparts. Purpose: Ensure equitable access to renal transplant by modifying the existing selection criteria at a faith-based institution to include eligible HIV infected candidates for renal transplantation. Methods: A single center, prospective observational cohort study was conducted to determine the influence of modifying selection criteria to include eligible HIV infected individuals with ESRD in reducing disparities for access to renal transplantation. As the theoretical framework, Lewin's Change Management model served to assess organizational readiness and permanency of selection criteria modification. Implementation Procedure: 329 dialysis units were notified in writing of the modified selection criteria with instructions on referring patients for renal transplantation. A comparative analysis of the volume of HIV infected ESRD patient referrals, evaluations, listings and transplants six months prior to and three months post. intervention was performed. Conclusions: Six HIV infected patients with ESRD were referred for renal transplantation postintervention which correlated to a 200% increase by volume. 33% advanced to the evaluation phase. None of the participants were activated to the waiting list or received a transplant. Additional observation is warranted to establish the efficacy or modifying selection criteria in increasing the access of HIV infected ESRD patients to renal transplantation.

Rights

Copyright 2019 all authors

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