What you might be thinking:
“My patient has not expressed an interest in transplant”:
According to OPTN (Organ Procurement and Transplantation Network), prior to transplant evaluation, many patients have no basis on which to have an opinion about transplant. Expecting patient interest prior to learning about their options may not be a fair basis to decide on referral for evaluation. Keep in mind that for every other standard of care therapy, patient interest is not a requisite criterion. For example, a patient referred for a heart catheterization is not expected to have knowledge of catheterization risk and benefits and alternatives. Rather, it is expected that the patient will be educated once he sees the cardiologist. Similarly, in transplant compared to dialysis, interest in transplantation should be appropriately gauged after transplant education has been provided and should not be part of the decision to refer for kidney transplant evaluation.
What you might be thinking:
“Waiting to refer until the patient has stabilized on dialysis is better”
According to a 2019 retrospective study in France, preemptive kidney transplant was associated with LOWER risk of graft failure than kidney transplant performed AFTER the initiation of dialysis, regardless of the duration of dialysis.
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