engleski

Successful Kidney Transplantation in a Functionally Illiterate Patient

Introduction: Functional illiteracy is still present in certain vulnerable groups, e.g. in Roma minority and in elderly, especially females. Estimates are that 0.8% of Croatian population is illiterate: 30 400 people, most of them women. Illiteracy is especially present in the Roma minority in Croatia, with only 10% of the minority having a high school degree, most never finishing primary education. Illiteracy imposes challenges on achieving optional healthcare availability and patient safety. It has been shown that it adversely influences outcomes: both expected life duration and quality. We present here a case of an illiterate ESRD patient who was successfully transplanted. Case presentation: The patient was referred to our institution as a transplant candidate. She was 62 years old, married, living with stepchildren and grandchildren. She was never enrolled in any formal education and was functionally illiterate. At the age of 55 she was diagnosed with CKD, due to DM and hypertension, and at the age of 60 haemodialysis was instituted. Husband was actively involved in her healthcare, accompanying her at almost every clinic visit. Compliance was low, and she often had hyperkalaemia and volume overload. After her nephew was successfully transplanted at our institution because of FSGS, she developed an interest in transplantation and compliance improved substantially. With time, pretransplant evaluation began at the local haemodialysis unit and she was referred to our centre. No medical contraindications were found, but the question of informed consent and further posttransplant compliance arose. After detailed conversations both with her alone, and together with the husband, it was determined that she is capable of self-care and understands well the nature of disease and the challenges transplantation sometimes imposes. She was most involved in the pretransplant evaluation and very punctuate and responsible. Informed consent was obtained with her individually but also with the husband present. She signed with a thumb print and the husband co-signed. At the age of 63 she was successfully transplanted from a DD with primary graft function. The posttransplant course was uneventful. At 1-year posttransplant graft function is excellent, with eGFR >90 mL/min/1.73 m². Discussion: Illiteracy comprises many challenges. Firstly, it makes the very process of decision- making and informing the patient more difficult. Also, it complicates the self-care of the patient and the opportunity to obtain information independently. Not less important, the validity of informed consent could come into question. In our case, we would like to emphasize that the patient had no intellectual disability. She was ready to learn about her illness and to follow medical instructions. Also, during the informed consent process and later during the transplant process, family support and involvement was crucial. Nevertheless, it is important to remember, as much the family members empower the illiterate patient and ease the healthcare process, that she is her own person and autonomy must be respected. Individual consultations must be performed and only afterwards the patient and the husband should be informed again together. Also, it is important to remember that underprivileged minorities such as the Roma minority have worse healthcare outcomes and that it is our responsibility as medical professionals to try to change that. The message of the case is that illiteracy is not a contraindication for transplantation, but only a barrier which can be overcome with good support and a personalized approach.

kidney transplantation, illiteracy, underprivileged

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