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

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dc.contributor.authorMoosa, Mohammed Rafiqueen_ZA
dc.contributor.authorMaree, Jonathan Daviden_ZA
dc.contributor.authorChirehwa, Maxwell Ten_ZA
dc.contributor.authorBenatar, Solomon Ren_ZA
dc.date.accessioned2016-10-31T07:32:44Z
dc.date.available2016-10-31T07:32:44Z
dc.date.issued2016en_ZA
dc.description.abstractUniversal 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.identifier.apacitationMoosa, 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. <i>PLoS One</i>, http://hdl.handle.net/11427/22339en_ZA
dc.identifier.chicagocitationMoosa, Mohammed Rafique, Jonathan David Maree, Maxwell T Chirehwa, and Solomon R Benatar "Use of the 'Accountability for Reasonableness' Approach to Improve Fairness in Accessing Dialysis in a Middle-Income Country." <i>PLoS One</i> (2016) http://hdl.handle.net/11427/22339en_ZA
dc.identifier.citationMoosa, 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.0164201en_ZA
dc.identifier.ris TY - Journal Article AU - Moosa, Mohammed Rafique AU - Maree, Jonathan David AU - Chirehwa, Maxwell T AU - Benatar, Solomon R AB - 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. DA - 2016 DB - OpenUCT DO - 10.1371/journal.pone.0164201 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - Use of the 'Accountability for Reasonableness' Approach to Improve Fairness in Accessing Dialysis in a Middle-Income Country TI - Use of the 'Accountability for Reasonableness' Approach to Improve Fairness in Accessing Dialysis in a Middle-Income Country UR - http://hdl.handle.net/11427/22339 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0164201en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/22339
dc.identifier.vancouvercitationMoosa MR, Maree JD, Chirehwa MT, Benatar SR. Use of the 'Accountability for Reasonableness' Approach to Improve Fairness in Accessing Dialysis in a Middle-Income Country. PLoS One. 2016; http://hdl.handle.net/11427/22339.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentCentre for Bioethicsen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis 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.holder© 2016 Moosa et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherMedical dialysisen_ZA
dc.subject.otherRenal transplantationen_ZA
dc.subject.otherChronic kidney diseaseen_ZA
dc.subject.otherDiabetes mellitusen_ZA
dc.subject.otherKidneysen_ZA
dc.subject.otherHIV infectionsen_ZA
dc.subject.otherHealth Economicsen_ZA
dc.subject.otherSouth Africaen_ZA
dc.titleUse of the 'Accountability for Reasonableness' Approach to Improve Fairness in Accessing Dialysis in a Middle-Income Countryen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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