SP 6.02 Managing Kidney Transplantation in Learning-Disabled Recipients: A Mixed-Methods Thematic Approach with Quantitative Prevalence and Ordered Interventions
Devanshu Aggarwal, Aleena Ilyas, Muneeba Saeed, Sanjay Mehra, Hemant SharmaAbstract
Background
People with learning-difficulties (LD) face systemic-barriers in accessing kidney-transplantation, yet their care pathways remain underexplored. This study examines structural barriers and interventions through multi-stakeholder perspectives to identify equity-mechanisms across the transplant pathway.
Methods
Mixed-methods-study employing qualitative thematic-analysis of structured questionnaires completed by 28 healthcare professionals (renal/transplant surgical residents, transplant coordinators, nephrologists, transplant surgeons, nurses, carers, and pharmacists) involved in care of patients with LD undergoing kidney-transplantation. Data underwent iterative thematic coding to identify barrier clusters. Theme prevalence was calculated as percentage of participants identifying each barrier as critical, with impact scores derived as composite measures of severity and frequency. Intervention priorities were ranked by consensus.
Results
Five major themes emerged: (1) Communication and cognitive barriers (68-85%): patients required simplified information delivery, visual aids, and teach-back verification; (2) Perioperative complications (65-95%): challenging anaesthesia induction and behavioural agitation necessitated family presence during induction (95% consensus); (3) Critical caregiver dependence (88-91%): lifelong medication adherence required continuous supervision; (4) Institutional resource limitations (71-82%): nursing staff shortages for one-to-one care and inadequate clinical spaces; (5) Policy and training gaps (71-78%): absence of clear clinical pathways and limited staff training. Healthcare teams prioritized dedicated care pathways (95%), specialist coordinators (92%), and caregiver support programs (89%).
Conclusions
Transplant access for recipients with LD reflects profound structural inequities requiring multi-level intervention. Essential reforms include dedicated clinical pathways with specialist nursing support, mandatory staff training, formalized caregiver education, elimination of rigid protocols, and transparent equity audits tracking outcomes by patient complexity.