Noncompliance a factor in transplant evaluation?

  1. In our unit we have a young man who continually skips and signs himself off early from treatments-- and he is on the transplant list. Our unit doesn't seem to put much weight on noncompliance when it comes to young patients seeking a transplant-- the thinking seems to be, "Get them transplanted before comorbidities make it more difficult."

    What do you do in your dialysis units with patients awaiting transplant who are noncompliant? Does that kick them off of the list, are they warned, or is no action taken?

    I am a former transplant patient, and I was relatively noncompliant before my transplant-- I got no counseling for it, and I became noncompliant with the transplant meds. When I see people going down the same road I went down, it bothers me that the underlying problem is never addressed because all the emphasis is on getting the patient transplanted.
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  2. 3 Comments

  3. by   talaxandra
    Non-compliance is definitely a factor in my unit. We've had a couple of patients who had to demonstrate 12 months of compliance before being accepted for living-related transplantation (both did very well).
    Unfortunately it took a pre-op non-compliant patient rejecting her kidney (she stopped taking cyclosporin because she was "sick of taking tablets all the time" - while I can certainly sympathise with that, no) for them to evaluate compliance as part of the work up.
  4. by   jnette
    Quote from talaxandra
    Non-compliance is definitely a factor in my unit. We've had a couple of patients who had to demonstrate 12 months of compliance before being accepted for living-related transplantation (both did very well).
    Unfortunately it took a pre-op non-compliant patient rejecting her kidney (she stopped taking cyclosporin because she was "sick of taking tablets all the time" - while I can certainly sympathise with that, no) for them to evaluate compliance as part of the work up.
    I agree... pretransplant compliance is a must. If they are noncompliant BEFOREHAND, they can well be expected to remain so post op, and neglect to take their meds, which are ESSENTIAL.

    While we have no specific policy in place such as mentioned above, we do speak to our patients about this, and let them know that the transplant folks look into this themselves, and are adamant about compliance, or they will (and DO) actually remove the patient from the list.
  5. by   babs_rn
    Our various transplant centers will automatically disqualify a chronically noncompliant patient. No sense wasting a perfectly good kidney on someone who won't take care of it.

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