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Human leukocyte antigen (HLA) molecular-compatibility-based organ allocation aims to reduce the risk of donor-specific antibody formation and thereby lower the risk of AMR. However, integrating molecular compatibility in organ allocation could introduce barriers to access, consequently raising ethical concerns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>The objective of this study was to gather perspectives of HLA professionals on molecular matching in kidney transplantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Individual semi-structured interviews.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting:<\/jats:title>\n                    <jats:p>Canadian HLA laboratories.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants:<\/jats:title>\n                    <jats:p>HLA laboratory directors or HLA professionals.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Seven participants took part in semi-structured interviews between January and June 2024. The interviews were digitally recorded, transcribed, and analyzed using the qualitative description approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Participants reported positive feelings regarding the current allocation system but highlighted that HLA matching could be improved. They differed on whether kidney allocation should prioritize medical utility or fairness. While acknowledging the potential benefits of precision medicine in improving transplant outcomes, experts emphasized that its implementation confronts both scientific uncertainties and practical challenges, identifying logistical, financial, technological, and occupational barriers. They expressed concerns regarding decreased access to kidney transplantation for marginalized groups, recommending the adoption of mitigation measures. Regarding the kidney-paired donation program, experts supported integrating molecular matching as an optimizing tool to complement the current algorithm. Participants recommended that future implementation of molecular matching in Canada should involve nationwide collaboration, establishing a maximum wait time and appropriate selection criteria, additional research, adequate staffing and funding for HLA laboratories, as well as education of transplant professionals and patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Limitations:<\/jats:title>\n                    <jats:p>The major limitation of this study is the small number of participants, all of whom were Canadian HLA professionals. Consequently, results may not be generalizable to transplant contexts in other countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>This study highlights the complexities of integrating molecular matching into organ allocation, raising concerns about equity, feasibility, and implementation. While HLA experts agree on the importance of ensuring equity and timely access, their perspectives also underscore the challenges of implementation, such as the availability of timely high-resolution HLA typing, stakeholder buy-in, and the need for dedicated tools and applications. To ensure an ethical and equitable implementation, future efforts must address access disparities through targeted mitigation strategies, such as the introduction of a maximum waiting time for a molecular-matched kidney.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20543581251412195","type":"journal-article","created":{"date-parts":[[2026,2,7]],"date-time":"2026-02-07T05:30:55Z","timestamp":1770442255000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["HLA Experts\u2019 Perspectives on Precision Medicine and Molecular Matching in Kidney Transplantation: A Qualitative Study"],"prefix":"10.1177","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-7833-5889","authenticated-orcid":false,"given":"Lucy","family":"An","sequence":"first","affiliation":[{"name":"Centre de recherche du Centre hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al, QC, Canada"},{"name":"Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aliya","family":"Affdal","sequence":"additional","affiliation":[{"name":"Centre de recherche du Centre hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al, QC, Canada"},{"name":"Bioethics Program, \u00c9cole de sant\u00e9 publique de l\u2019Universit\u00e9 de Montreal, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fabian","family":"Ballesteros","sequence":"additional","affiliation":[{"name":"Centre hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie-Fran\u00e7oise","family":"Malo","sequence":"additional","affiliation":[{"name":"Centre de recherche du Centre hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al, QC, Canada"},{"name":"Bioethics Program, \u00c9cole de sant\u00e9 publique de l\u2019Universit\u00e9 de Montreal, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Savannah-Lou","family":"Cochran-Mavrikakis","sequence":"additional","affiliation":[{"name":"Department of Philosophy, Universit\u00e9 de Montr\u00e9al, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carina","family":"Sancho","sequence":"additional","affiliation":[{"name":"Centre de recherche du Centre hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"No\u00e9mi","family":"Tousignant","sequence":"additional","affiliation":[{"name":"Centre de recherche du Centre hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stirling","family":"Bryan","sequence":"additional","affiliation":[{"name":"School of Population and Public Health, University of British Columbia, Vancouver, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul","family":"Keown","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of British Columbia, Vancouver, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0745-004X","authenticated-orcid":false,"given":"Ruth","family":"Sapir-Pichhadze","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada"},{"name":"Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8437-0556","authenticated-orcid":false,"given":"Marie-Chantal","family":"Fortin","sequence":"additional","affiliation":[{"name":"Centre de recherche du Centre hospitalier de l\u2019Universit\u00e9 de Montr\u00e9al, QC, Canada"},{"name":"Canadian Donation and Transplantation Research Program, Edmonton, AB, Canada"},{"name":"Faculty of Medicine, Universit\u00e9 de Montr\u00e9al, QC, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,2,6]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/nejm199912023412303"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfab232"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.3389\/ti.2024.12071"},{"key":"e_1_3_2_5_2","unstructured":"Canadian Institute for Health Information. 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