Article type
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Abstract
Background: Clinical practice guidelines (CPGs) and consensus statements provide a basis for implementing research evidence, clinical expertise and patient preferences. In living kidney donation, donors face the risk of acute surgical complications and psychosocial harm; and in practice, there is variability in donor screening and follow up.
Objectives: To compare the quality, scope, content and consistency of international CPGs and consensus statements on the assessment and care of living kidney donors.
Methods: We searched for CPGs and consensus statements for living kidney donation in electronic databases and guideline registries up to 21 February 2011. The methodological quality of guidelines was assessed using the Appraisal of Guidelines for Research and Education (AGREE) instrument. A descriptive textual synthesis was used to analyse and compare guideline recommendations and consensus statements.
Results: Seven CPGs and one consensus statement were included. Three indicated the levels of evidence underpinning the evidence, only one graded their recommendations. Lack of explicitness about the methodology and development of CPGs/consensus statements was apparent. While a comprehensive range of relevant topics were covered, the scope varied considerably between each CPG/consensus statement. Across guidelines, there was slight variability in thresholds for clinical contraindications for live kidney donation. A major discrepancy concerned the acceptance of minor (under 18 years) kidney donors. The importance of informed voluntary consent, genuine altruistic motivation, adequate support, and psychological health and resilience were recognised but specific guidance or tools for conducting psychosocial assessments were lacking.
Conclusions: Comprehensive and rigorously developed guidelines which include explicit links to high-quality evidence, graded recommendations, and specific tools for evaluating the medical and psychosocial well-being of living kidney donors may promote the uptake and implementation of evidence and CPGs in clinical practice. This can lead to better screening and care of living kidney donors to minimise acute surgical complications, mortality and psychosocial harms.
Objectives: To compare the quality, scope, content and consistency of international CPGs and consensus statements on the assessment and care of living kidney donors.
Methods: We searched for CPGs and consensus statements for living kidney donation in electronic databases and guideline registries up to 21 February 2011. The methodological quality of guidelines was assessed using the Appraisal of Guidelines for Research and Education (AGREE) instrument. A descriptive textual synthesis was used to analyse and compare guideline recommendations and consensus statements.
Results: Seven CPGs and one consensus statement were included. Three indicated the levels of evidence underpinning the evidence, only one graded their recommendations. Lack of explicitness about the methodology and development of CPGs/consensus statements was apparent. While a comprehensive range of relevant topics were covered, the scope varied considerably between each CPG/consensus statement. Across guidelines, there was slight variability in thresholds for clinical contraindications for live kidney donation. A major discrepancy concerned the acceptance of minor (under 18 years) kidney donors. The importance of informed voluntary consent, genuine altruistic motivation, adequate support, and psychological health and resilience were recognised but specific guidance or tools for conducting psychosocial assessments were lacking.
Conclusions: Comprehensive and rigorously developed guidelines which include explicit links to high-quality evidence, graded recommendations, and specific tools for evaluating the medical and psychosocial well-being of living kidney donors may promote the uptake and implementation of evidence and CPGs in clinical practice. This can lead to better screening and care of living kidney donors to minimise acute surgical complications, mortality and psychosocial harms.