The purpose of this proposed study is to explore the perceptions and attitudes of hospital pathologists in the local OPO donor service area surrounding requests to perform routine kidney biopsies to determine suitability for transplantation. It is hoped that gaining an understanding of patterns of reluctance and refusal will aid in developing education to inform both the OPO and pathologists on evidence-based practices for securing pathology services, thereby reducing unnecessary kidney discards and fostering better OPO-pathologist relationships.
There are over 103,000 people on the waitlist for a solid organ transplant. Over 80% of those are waiting for a kidney. Every day, 13 people die while waiting for a transplant. Every 8 minutes, another person is added to the national waitlist. The need for organs for transplant continues to outpace the number of organs available.
Despite the tremendous need, approximately one in five kidneys recovered for transplant are discarded (National Academies of Science, Engineering, and Medicine, 2017). The most common reasons cited are cold ischemic time (CIT) (the amount of time an organ is without perfusion) and biopsy results (Mohan et al., 2018). The need to obtain a kidney biopsy, be it a request or requirement, can potentially prolong CIT, especially if the pathologist at the recovery location is unable to perform kidney biopsy reads.
Kidney biopsies are routinely used as part of the acceptance criteria for organ transplant suitability. Approximately 20% of kidneys procured for transplantation are discarded, partly due to concerns about quality informed by biopsy findings. Transplant professionals have identified multiple issues with the use of biopsies, including a shortage of renal pathologists with the necessary expertise to interpret biopsy results accurately (Schantz et al., 2022). Organ procurement organizations (OPOs) have consistently requested hospital pathology services to assist in the processing and interpretation of biopsies obtained during the recovery process (Emmons et al., 2021). These requests have been met with reluctance and/or refusal. Education surrounding informed practice for obtaining the most appropriate provider for biopsy services is lacking.
My name is Sharon Swain. I am a critical care nurse by background and have worked for an Organ Procurement Organization for 21 years. I have been involved in research efforts aimed at improving deceased donor management. I am currently pursuing my doctorate and am requesting the assistance of hospital pathologists.
You are eligible to participate in this research if you are a Board Certified Pathologist practicing in an acute care setting. To review the informed consent form, please click below. Please note that a review of the consent form is required for participation in this study.
A brief 21-question survey has been developed based on the lived experiences of, and feedback from, hospital pathologists who have been asked to provide services for the local OPO.
Please share this site with other hospital pathologists in your network.
Your feedback is crucial to me and the project's success. If you have any suggestions or would like to make further inquiries, please don't hesitate to contact me at sharon@pathologyresearch.org.
If you wish to learn more about organ donation, please click on the link below.
Dr. Margaret Ryan is a consultant for Mayo Clinic and is passionate about kidney transplantation. She has developed a presentation to assist pathologists in the interpretation of biopsies from kidneys intended for transplant.