Use of the 'Accountability for Reasonableness' Approach to Improve Fairness in Accessing Dialysis in a Middle-Income Country

 

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dc.contributor.author Moosa, Mohammed Rafique en_ZA
dc.contributor.author Maree, Jonathan David en_ZA
dc.contributor.author Chirehwa, Maxwell T en_ZA
dc.contributor.author Benatar, Solomon R en_ZA
dc.date.accessioned 2016-10-31T07:32:44Z
dc.date.available 2016-10-31T07:32:44Z
dc.date.issued 2016 en_ZA
dc.identifier.citation Moosa, M. R., Maree, J. D., Chirehwa, M. T., & Benatar, S. R. (2016). Use of the ‘Accountability for Reasonableness’ Approach to Improve Fairness in Accessing Dialysis in a Middle-Income Country. PloS one, 11(10), e0164201. doi:10.1371/journal.pone.0164201 en_ZA
dc.identifier.uri http://dx.doi.org/10.1371/journal.pone.0164201 en_ZA
dc.identifier.uri http://hdl.handle.net/11427/22339
dc.description.abstract Universal access to renal replacement therapy is beyond the economic capability of most low and middle-income countries due to large patient numbers and the high recurrent cost of treating end stage kidney disease. In countries where limited access is available, no systems exist that allow for optimal use of the scarce dialysis facilities. We previously reported that using national guidelines to select patients for renal replacement therapy resulted in biased allocation. We reengineered selection guidelines using the 'Accountability for Reasonableness' (procedural fairness) framework in collaboration with relevant stakeholders, applying these in a novel way to categorize and prioritize patients in a unique hierarchical fashion. The guidelines were primarily premised on patients being transplantable. We examined whether the revised guidelines enhanced fairness of dialysis resource allocation. This is a descriptive study of 1101 end stage kidney failure patients presenting to a tertiary renal unit in a middle-income country, evaluated for dialysis treatment over a seven-year period. The Assessment Committee used the accountability for reasonableness-based guidelines to allocate patients to one of three assessment groups. Category 1 patients were guaranteed renal replacement therapy, Category 3 patients were palliated, and Category 2 were offered treatment if resources allowed. Only 25.2% of all end stage kidney disease patients assessed were accepted for renal replacement treatment. The majority of patients (48%) were allocated to Category 2. Of 134 Category 1 patients, 98% were accepted for treatment while 438 (99.5%) Category 3 patients were excluded. Compared with those palliated, patients accepted for dialysis treatment were almost 10 years younger, employed, married with children and not diabetic. Compared with our previous selection process our current method of priority setting based on procedural fairness arguably resulted in more equitable allocation of treatment but, more importantly, it is a model that is morally, legally and ethically more defensible. en_ZA
dc.language.iso eng en_ZA
dc.publisher Public Library of Science en_ZA
dc.rights This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. en_ZA
dc.rights.uri http://creativecommons.org/licenses/by/4.0 en_ZA
dc.source PLoS One en_ZA
dc.source.uri http://journals.plos.org/plosone en_ZA
dc.subject.other Medical dialysis en_ZA
dc.subject.other Renal transplantation en_ZA
dc.subject.other Chronic kidney disease en_ZA
dc.subject.other Diabetes mellitus en_ZA
dc.subject.other Kidneys en_ZA
dc.subject.other HIV infections en_ZA
dc.subject.other Health Economics en_ZA
dc.subject.other South Africa en_ZA
dc.title Use of the 'Accountability for Reasonableness' Approach to Improve Fairness in Accessing Dialysis in a Middle-Income Country en_ZA
dc.type Journal Article en_ZA
dc.rights.holder © 2016 Moosa et al en_ZA
uct.type.publication Research en_ZA
uct.type.resource Article en_ZA
dc.publisher.institution University of Cape Town
dc.publisher.faculty Faculty of Health Sciences en_ZA
dc.publisher.department Centre for Bioethics en_ZA
uct.type.filetype Text
uct.type.filetype Image


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This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Except where otherwise noted, this item's license is described as This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.