Managing uncertainty in multidisciplinary renal team meetings: decision-making processes and complex challenges in kidney transplant listing

Abstract

Multidisciplinary team (MDT) meetings are common to many fields of medicine and widely established internationally. They are intended to ensure higher-quality decision-making and improved patient outcomes. For patients with end-stage kidney disease (ESKD), decisions on whether to place marginally suitable candidates on the kidney transplantation waiting list can be challenging and as such they are supported by MDT meetings. Uncertainty in terms of the best course of action can be linked with a dearth of knowledge or evidence on specific medical conditions and likely implications for successful transplantation, but also on unforeseen outcomes influenced by patient behaviours. In this project, we observed how MDT meetings work in practice in kidney transplant listing, unpacking issues of risk and uncertainty in transplant decision-making processes. Our findings indicate that a central value of MDT meetings is managing medical uncertainty and psychosocial risks, and distributing responsibility for complex transplant listing decisions to ensure equity of access to transplantation as well as an efficient use of scarce kidneys. This sheds light on strategies enacted to mitigate these risks and uncertainties, and the role played by different types of knowledge (experiential versus scientifically evidence-based) in the overall decision-making process.