Transplantation. 98(5):520-528, September 15, 2014.
Equity of access to kidney transplantation, as for other medical and surgical interventions, is a not unreasonable expectation of patients and their families. Patients expect not only equity of access to donated organs from deceased donors but also equity of access to treatment. This study from Israni and colleagues reports the findings of a survey they undertook of the 208 adult kidney transplant centers in the US. Of these, three quarters responded. The questionnaire covered many aspects of care including the structure and process of care, including who provided the care and the extent of ancillary health care professional involvement, the frequency of follow-up visits, the coordination of care and the pattern of care. Not surprisingly, there are many intriguing differences between the transplant centers in how care is delivered, and the authors highlight some of these differences, such as variations in the extent to which pharmacists are involved, the collaboration between surgeons and physicians and the protocols used.
Assuming that the respondents were accurate in their replies, should health care professionals, commissioners and users of the service be dismayed or encouraged by the findings? The view of this editor at least, is that all units should operate to common basic standards of care but thereafter variation is healthy: not only will different circumstances dictate different practices, but by studying differences in delivery of care we can learn how to improve our services. If everyone worked to the same standards, there would e equity but improvements would be slow. By encouraging diversity, patient care can be improved as long as minimal standards are maintained and clinicians and others look critically at variation and see how this can inform and improve practice. This study, demonstrates there are differences but not which practices improve care and which should be abandoned. Equity and uniformity are distinct: the former necessary but the latter may be less than beneficial.