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Aimee Sarti,1 Stephanie Sutherland,1 Angele Landriault,2 Sonny Dhanani,3 Andrew Healey,4 Pierre Cardinal1 1Department of Critical Care, Ottawa Hospital, Ottawa, ON, Canada; 2Practice and Performance Unit, Royal College of Physicians and Surgeons of Canada (RCPSC), Ottawa, ON, Canada; 3Department of Pediatrics, University of Ottawa, Children’s Hospital of Eastern Ontario (CHEO), Ottawa, ON, Canada; 4Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, CanadaCorrespondence: Aimee Sarti Email asarti@toh.caBackground: The demand for solid organ transplantation has spurred countries around the world to search for innovative policies and practices to increase the supply of organs. Spain has become a global reference point for organ donation with the highest transplantation rates. In Ontario, Canada the Ontario Trillium Gift of Life (TGLN) has sought to replicate some of the successes in Spain. In particular, TGLN’s implementation of the Physician Leadership Model has been viewed as a promising strategy to improve donation conversion rates.Objective: The objective of this study was to evaluate the implementation of TGLNs (TGLN) Physician Leadership Model by examining critical implementation process variables (education/training, communication, satisfaction, participation and reach).Methods: This mixed-method implementation evaluation included data from all members of the Physician Leadership Model including the Chief Medical Officer, five Regional Medical Leads (RMLs), and the 52 Hospital Donation Physicians (HDPs). Social Network Analysis (SNA) surveys were sent to all 52 HDPs and yielded an 85% rate. Analysis included constructing sociograms and qualitatively analyzing interviews.Results: TGLN’s PLM was poised for success by utilizing the existing RMLs’ network as a foundation. The social network analysis measures, particularly participation and reach, indicated the PLM was quite dense (ie, the degree to which members are connected) at baseline. HDPs reported communication to be facilitated by their connections to their RMLs. Early evaluative data indicated that lack of education and training was viewed by HDPs as a barrier, and thus more capacity would need to be directed to this issue. Overall, HDPs reported that various intended outcomes were being met.Conclusion: We have demonstrated that an implementation evaluation helps us to understand which elements of the PLM were successful and which elements required immediate attention. This evaluation helped to highlight the successes and challenges in implementing the TGLN Physician Leadership Model in Ontario. Social network analysis of publicly funded capacity building systems has been identified as a promising area for health program evaluation to answer questions at a system level, such as identifying service provisions among information exchange networks and ultimately better health care.Keywords: implementation evaluation, organ and tissue donation, social network mapping, leadership

BACKGROUND: Interest in modifiable risk factors (MRFs) for dementia is high, given the personal, social, and economic impact of the disorder, especially in ageing societies such as the United Kingdom. Exploring the population attributable fraction (PAF) of dementia attributable to MRFs and how this may have changed over time remains unclear. Unravelling the temporal dynamics of MRFs is crucial for informing the development of evidence-based and effective public health policies. This investigation examined the temporal trajectories of MRFs for dementia in England. METHODS: We used data from the English Longitudinal Study of Ageing, a panel study over eight waves collected between 2004 and 2019 (76,904 interviews in total). We calculated the PAFs for twelve MRFs (including six early- to mid-life factors and six late-life factors), as recommended by the Lancet Commission, and the individual weighted PAFs (IW-PAFs) for each risk factor. Temporal trends were analysed to understand the changes in the overall PAF and IW-PAF over the study period. Subgroup analyses were conducted by sex and socioeconomic status (SES). RESULTS: The overall PAF for dementia MRFs changed from 46.73% in 2004/2005 to 36.79% in 2018/2019, though this trend was not statistically significant. During 2004-2019, hypertension, with an average IW-PAF of 8.21%, was the primary modifiable determinant of dementia, followed by obesity (6.16%), social isolation (5.61%), hearing loss (4.81%), depression (4.72%), low education (4.63%), physical inactivity (3.26%), diabetes mellitus (2.49%), smoking (2.0%), excessive alcohol consumption (1.16%), air pollution (0.42%), and traumatic brain injury (TBI) (0.26%). During 2004-2019, only IW-PAFs of low education, social isolation, and smoking showed significant decreasing trends, while IW-PAFs of other factors either did not change significantly or increased (including TBI, diabetes mellitus, and air pollution). Upon sex-specific disaggregation, a higher overall PAF for MRFs was found among women, predominantly associated with later-life risk factors, most notably social isolation, depression, and physical inactivity. Additionally, hearing loss, classified as an early- to mid-life factor, played a supplementary role in the identified sex disparity. A comparable discrepancy was evident upon PAF evaluation by SES, with lower income groups experiencing a higher dementia risk, largely tied to later-life factors such as social isolation, physical inactivity, depression, and smoking. Early- to mid-life factors, in particular, low education and obesity, were also observed to contribute to the SES-associated divergence in dementia risk. Temporal PAF and IW-PAF trends, stratified by sex and SES, revealed that MRF PAF gaps across sex or SES categories have persisted or increased. CONCLUSIONS: In England, there was little change over time in the proportion of dementia attributable to known modifiable risk factors. The observed trends underscore the continuing relevance of these risk factors and the need for targeted public health strategies to address them.

Aimee J Sarti,1 Stephanie Sutherland,1 Angele Landriault,2 Kirk DesRosier,2 Susan Brien,2 Pierre Cardinal1 1Department of Critical Care, The Ottawa Hospital, 2The Royal College of Physicians and Surgeons of Canada, Ottawa, ON, Canada Introduction: Evaluation capacity building (ECB) is a topic of great interest to many organizations as they face increasing demands for accountability and evidence-based practices. ECB is about building the knowledge, skills, and attitudes of organizational members, the sustainability of rigorous evaluative practices, and providing the resources and motivations to engage in ongoing evaluative work. There exists a solid foundation of theoretical research on ECB, however, understanding what ECB looks like in practice is relatively thin. Our purpose was to investigate what ECB looks like firsthand within a national medical educational organization. Methods: The context for this study was the Acute Critical Events Simulation (ACES) organization in Canada, which has successfully evolved into a national educational program, driven by physicians. We conducted an exploratory qualitative study to better understand and describe ECB in practice. In doing so, interviews were conducted with program leaders and instructors so as to gain a richer understanding of evaluative processes and practices. Results: A total of 21 individuals participated in the semistructured interviews. Themes from our qualitative data analysis included the following: evaluation knowledge, skills, and attitudes, use of evaluation findings, shared evaluation beliefs and commitment, evaluation frameworks and processes, and resources dedicated to evaluation. Conclusion: The national ACES organization was a useful case study to explore ECB in practice. The ECB literature provided a solid foundation to understand the purpose and nuances of ECB. This study added to the paucity of studies focused on examining ECB in practice. The most important lesson learned was that the organization must have leadership who are intrinsically motivated to employ and use evaluation data to drive ongoing improvements within the organization. Leaders who are intrinsically motivated will employ risk taking when evaluation practices and processes may be somewhat unfamiliar. Creating and maintaining a culture of data use and ongoing inquiry have enabled national ACES to achieve a sustainable evaluation practice. Keywords: evaluation capacity building, data use, program evaluation, quality improvement, leadership

Objective: To review the physical activity promotion efforts of Power 5 conference institutions' summer transition programs. Methods: The websites of Power 5 Conference and affiliate member institutions (N = 78) were systematically reviewed and information on summer transition programs pertaining to health were extracted. Results: Most (n = 45, 57.7%) institutions had a summer transition program of some kind. Among those who had summer transition programs, 14 (31.1%) had a nonphysical activity health course (i.e. health and/or nutrition), while courses that incorporated a physical activity component were uncommon (n = 6, 13.3%). Only two institutions covered physical activity, nutrition, and health in at least one offered course. Conclusions: There is an opportunity for tertiary institution-level summer transitional programs to expand coverage to address a currently unmet need for physical activity promotion while avoiding perpetuation of existing inequities.

Pedagogical approaches for supporting students' argumentative writing in science laboratories have not been fully established. This article examines the development of argumentative abilities in undergraduate students enrolled in chemistry laboratory courses that employed two teaching sequences: (i) an argumentative writing workshop for conceptual learning and (ii) weekly laboratory report writing for application of knowledge gained in the workshop. The four workshop modules guided students through the process of identifying three key components of arguments (evidence, justifications, and claims), selecting appropriate and inappropriate justifications, constructing justifications and conclusions, and analyzing experimental errors. Student performance in formulating scientific arguments was evaluated through instructors' assessment of evidence, justifications, and claims made in the Results, Discussion, and Conclusions sections, respectively, of a laboratory report. Student performance improved from 60.9 ± 3.4 to 91.5 ± 8.0 in Introductory Chemistry I Lab and 60.7 ± 5.2 to 91.7 ± 5.4 in Introductory Chemistry II Lab. Students rated the helpfulness of the writing workshop ([3.6 ± 0.1]/5.0), weekly writing ([4.1 ± 0.3]/5.0), and instructors' feedback ([4.4 ± 0.5]/5.0) for both introductory and advanced chemistry laboratories positively. The format of this writing workshop can be used for online teaching or incorporated into any science laboratory course with the development of appropriate content modules.

Abstract Sepia melanin, a biopigment extracted from the ink sac of cuttlefish, is relevant to sustainable organic electronics. In this work, we flexographically print films from an ink of Sepia melanin including shellac as a bio-sourced binder on silver electrode-patterned paper. We examine the electrical response in high humidity and ambient conditions (here the electronic conductivity is as high as 10−4 S/cm). Additionally, we study the biodegradation of the printed films and their individual constituents based on their mineralization into CO2 under composting conditions. The printed films exhibit biodegradation levels of about 97 ± 25% in 85 d. We observe microorganism colonization on the printed film’s surface. The analysis of the microbial community on the compost reveals that bacterial species within the Acidimicrobiia class, specifically Actinomarinales order, are potentially responsible for the biodegradation of the printed film. Meanwhile, ecotoxicity tests conducted by germinating Lolium multiflorum and Tagetes erecta suggest that printed films have negligible phytotoxicity.

Abstract Background The Gran Chaco ecoregion is a well-known hotspot of several neglected tropical diseases (NTDs) including Chagas disease, soil-transmitted helminthiasis and multiparasitic infections. Interspecific interactions between parasite species can modify host susceptibility, pathogenesis and transmissibility through immunomodulation. Our objective was to test the association between human co-infection with intestinal parasites and host parasitaemia, infectiousness to the vector and immunological profiles in Trypanosoma cruzi-seropositive individuals residing in an endemic region of the Argentine Chaco. Methods We conducted a cross-sectional serological survey for T. cruzi infection along with an intestinal parasite survey in two adjacent rural villages. Each participant was tested for T. cruzi and Strongyloides stercoralis infection by serodiagnosis, and by coprological tests for intestinal parasite detection. Trypanosoma cruzi bloodstream parasite load was determined by quantitative PCR (qPCR), host infectiousness by artificial xenodiagnosis and serum human cytokine levels by flow cytometry. Results The seroprevalence for T. cruzi was 16.1% and for S. stercoralis 11.5% (n = 87). We found 25.3% of patients with Enterobius vermicularis. The most frequent protozoan parasites were Blastocystis spp. (39.1%), Giardia lamblia (6.9%) and Cryptosporidium spp. (3.4%). Multiparasitism occurred in 36.8% of the examined patients. Co-infection ranged from 6.9% to 8.1% for T. cruzi-seropositive humans simultaneously infected with at least one protozoan or helminth species, respectively. The relative odds of being positive by qPCR or xenodiagnosis (i.e. infectious) of 28 T. cruzi-seropositive patients was eight times higher in people co-infected with at least one helminth species than in patients with no such co-infection. Trypanosoma cruzi parasite load and host infectiousness were positively associated with helminth co-infection in a multiple regression analysis. Interferon-gamma (IFN-γ) response, measured in relation to interleukin (IL)-4 among humans infected with T. cruzi only, was 1.5-fold higher than for T. cruzi-seropositive patients co-infected with helminths. The median concentration of IL-4 was significantly higher in T. cruzi-seropositive patients with a positive qPCR test than in qPCR-negative patients. Conclusions Our results show a high level of multiparasitism and suggest that co-infection with intestinal helminths increased T. cruzi parasitaemia and upregulated the Th2-type response in the study patients. Graphical Abstract

Abstract Background The emergence of pyrethroid resistance has threatened the elimination of Triatoma infestans from the Gran Chaco ecoregion. We investigated the status and spatial distribution of house infestation with T. infestans and its main determinants in Castelli, a municipality of the Argentine Chaco with record levels of triatomine pyrethroid resistance, persistent infestation over 2005–2014, and limited or no control actions over 2015–2020. Methods We conducted a 2-year longitudinal survey to assess triatomine infestation by timed manual searches in a well-defined rural section of Castelli including 14 villages and 234 inhabited houses in 2018 (baseline) and 2020, collected housing and sociodemographic data by on-site inspection and a tailored questionnaire, and synthetized these data into three indices generated by multiple correspondence analysis. Results The overall prevalence of house infestation in 2018 (33.8%) and 2020 (31.6%) virtually matched the historical estimates for the period 2005–2014 (33.7%) under recurrent pyrethroid sprays. While mean peridomestic infestation remained the same (26.4–26.7%) between 2018 and 2020, domestic infestation slightly decreased from 12.2 to 8.3%. Key triatomine habitats were storerooms, domiciles, kitchens, and structures occupied by chickens. Local spatial analysis showed significant aggregation of infestation and bug abundance in five villages, four of which had very high pyrethroid resistance approximately over 2010–2013, suggesting persistent infestations over space-time. House bug abundance within the hotspots consistently exceeded the estimates recorded in other villages. Multiple regression analysis revealed that the presence and relative abundance of T. infestans in domiciles were strongly and negatively associated with indices for household preventive practices (pesticide use) and housing quality. Questionnaire-derived information showed extensive use of pyrethroids associated with livestock raising and concomitant spillover treatment of dogs and (peri) domestic premises. Conclusions Triatoma infestans populations in an area with high pyrethroid resistance showed slow recovery and propagation rates despite limited or marginal control actions over a 5-year period. Consistent with these patterns, independent experiments confirmed the lower fitness of pyrethroid-resistant triatomines in Castelli compared with susceptible conspecifics. Targeting hotspots and pyrethroid-resistant foci with appropriate house modification measures and judicious application of alternative insecticides with adequate toxicity profiles are needed to suppress resistant triatomine populations and prevent their eventual regional spread. Graphical Abstract

IntroductionAnimal models suggest a protective role of angiotensin-converting enzyme inhibitors (ACEi) and angiotensin-II receptor blockers (ARBs) in reducing renal and cardiac ischemia-reperfusion injury. Our aim was to determine the association between pre-transplant ACEi/ARBs use and the occurrence of delayed graft function (DGF) in patients who received a kidney transplantation from a deceased donor.MethodsConsecutive recipients between 2008 and 2021 in 2 Canadian university-affiliated centers were included in this retrospective cohort study. The main outcome was the occurrence of DGF and the exposure was use of ACEi or ARBs at the time of admission for transplantation. Mixed models were fit.ResultsA total of 897 patients were included, of which 160 (18%) experienced DGF. At admission, 337 (38%) patients were exposed to ACEi/ARBs. In the multivariable analysis, pre-transplant ACEi/ARBs use was associated with a reduced risk of DGF (odds ratio: 0.60, 95% confidence interval: 0.40, 0.92). Other factors associated with DGF were recipient obesity, donor type, ethnicity, age, hypertension, and total ischemia time.DiscussionPre-transplant use of ACEi/ARBs is associated with a lower risk of DGF in early postoperative period, which may be due to a protective effect of these agents on renal ischemia-reperfusion injury.

Abstract Background Interest in modifiable risk factors (MRFs) for dementia is high, given the personal, social, and economic impact of the disorder, especially in ageing societies such as the United Kingdom. Exploring the population attributable fraction (PAF) of dementia attributable to MRFs and how this may have changed over time remains unclear. Unravelling the temporal dynamics of MRFs is crucial for informing the development of evidence-based and effective public health policies. This investigation examined the temporal trajectories of MRFs for dementia in England. Methods We used data from the English Longitudinal Study of Ageing, a panel study over eight waves collected between 2004 and 2019 (76,904 interviews in total). We calculated the PAFs for twelve MRFs (including six early- to mid-life factors and six late-life factors), as recommended by the Lancet Commission, and the individual weighted PAFs (IW-PAFs) for each risk factor. Temporal trends were analysed to understand the changes in the overall PAF and IW-PAF over the study period. Subgroup analyses were conducted by sex and socioeconomic status (SES). Results The overall PAF for dementia MRFs changed from 46.73% in 2004/2005 to 36.79% in 2018/2019, though this trend was not statistically significant. During 2004–2019, hypertension, with an average IW-PAF of 8.21%, was the primary modifiable determinant of dementia, followed by obesity (6.16%), social isolation (5.61%), hearing loss (4.81%), depression (4.72%), low education (4.63%), physical inactivity (3.26%), diabetes mellitus (2.49%), smoking (2.0%), excessive alcohol consumption (1.16%), air pollution (0.42%), and traumatic brain injury (TBI) (0.26%). During 2004–2019, only IW-PAFs of low education, social isolation, and smoking showed significant decreasing trends, while IW-PAFs of other factors either did not change significantly or increased (including TBI, diabetes mellitus, and air pollution). Upon sex-specific disaggregation, a higher overall PAF for MRFs was found among women, predominantly associated with later-life risk factors, most notably social isolation, depression, and physical inactivity. Additionally, hearing loss, classified as an early- to mid-life factor, played a supplementary role in the identified sex disparity. A comparable discrepancy was evident upon PAF evaluation by SES, with lower income groups experiencing a higher dementia risk, largely tied to later-life factors such as social isolation, physical inactivity, depression, and smoking. Early- to mid-life factors, in particular, low education and obesity, were also observed to contribute to the SES-associated divergence in dementia risk. Temporal PAF and IW-PAF trends, stratified by sex and SES, revealed that MRF PAF gaps across sex or SES categories have persisted or increased. Conclusions In England, there was little change over time in the proportion of dementia attributable to known modifiable risk factors. The observed trends underscore the continuing relevance of these risk factors and the need for targeted public health strategies to address them.

Éloïse Cardinal,1,2 Karine Bilodeau,2,3 Julie Lebeau,2,3 Maryse Aubin,2 Joséphine Guiné,2 Odile Dutey-Harispe,2 Julie Delage,1,2 Rémi Caron-trahan,1,2 Jade Véronneau,2 Mathieu Landry,1,2 David Ogez2,4 1Department of Psychology, Faculty of Arts and Sciences, University of Montreal, Montreal, Quebec, Canada; 2Centre de recherche de l’Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada; 3Faculty of Nursing Sciences, University of Montreal, Montreal, Quebec, Canada; 4Department of Anesthesiology and Pain Medicine, Faculty of Medicine, University of Montreal, Montreal, Quebec, CanadaCorrespondence: David Ogez, Tel +1 (514) 252-3400 X 4443, Email david.ogez@umontreal.caContext: One in four Canadians experiences chronic pain, yet insufficient services and restrictions surrounding prevailing treatments result in inadequate management and significant negative consequences for these individuals. Previous work indicates that hypnotic communication represents a promising complementary treatment; however, training protocols for healthcare professionals are underdeveloped and understudied.Aim: To evaluate the level of satisfaction for a training program on hypnotic communication in pain management clinics.Design: Qualitative study.Methods: Six health professionals who first completed the hypnotic communication training participated in 30 minutes virtual semi-structured interviews. These testimonials allowed them to elaborate on their user experience and potential areas for improvement. Thematic analysis using qualitative data management software NVIVO was conducted on the interview data.Results: Two themes emerged from the interviews. 1) Satisfaction: Participants expressed satisfaction on various structural aspects of the training, including the provided materials, atmosphere, training structure, presentation modalities, practical workshops, acquired knowledge, trainer quality, and training duration. 2) Areas for Improvement: Five main improvement suggestions were identified (providing more material; more practical workshops, more concrete and adapted; testimonials from former patients; follow-up training meeting; and continuing education).Implications for the Profession and/or Patient Care and Conclusion: The results improved the training program to help minimized inherent biases related to this technique, cut associated costs, and identify reasons that would explain its underutilization among medical professionals in Quebec. Our work highlights that healthcare professionals in chronic pain management clinics (eg, respiratory therapists, nurses) can incorporate this simple hypnotic communication technique into their usual care and contribute to the well-being of patients.Impact: This study aimed to address the lack of training protocols for healthcare professionals, that are underdeveloped and understudied. The main findings on participant’ satisfaction and the areas of improvement for the training will help the refinement of the training to better suit healthcare professional’s needs in hospitals and chronic pain facilities.Keywords: chronic pain, non-pharmacological treatment, hypnosis, communication, training, qualitative research, satisfaction

Abstract Avoidant restrictive food intake disorder (ARFID) is an eating disorder characterized by persistent insufficient nutritional and/or energy intake. ARFID, before referred to as “selective eating disorder”, was introduced recently in the DSM-5 as a replacement for and expansion of the previous diagnosis. Individuals with ARFID may limit food variety and intake due to avoidance based on the sensory characteristics of the food or related to any adverse consequences of eating without the intention of losing weight and concerns of body image. The limited understanding of avoidant and restrictive eating poses challenges to effective treatment and management, impacting directly on the growth and development of children and adolescents. The ARFID neurobiological concept has not yet been clearly defined to clinical practice for nutritionists, thereby hindering screening and impeding the development of treatment recommendations. This narrative review provide useful practical information to consult the pathophysiology, the neurobiology, the clinical features, the assessment and the treatment for healthcare professionals seeking to enhance their clinical knowledge and management of this disorder.

Abstract Background Chagas disease, caused by Trypanosoma cruzi, is still a public health problem in Latin America and in the Southern Cone countries, where Triatoma infestans is the main vector. We evaluated the relationships among the density of green vegetation around rural houses, sociodemographic characteristics, and domestic (re)infestation with T. infestans while accounting for their spatial dependence in the municipality of Pampa del Indio between 2007 and 2016. Methods The study comprised sociodemographic and ecological variables from 734 rural houses with no missing data. Green vegetation density surrounding houses was estimated by the normalized difference vegetation index (NDVI). We used a hierarchical Bayesian logistic regression composed of fixed effects and spatial random effects to estimate domestic infestation risk and quantile regressions to evaluate the association between surrounding NDVI and selected sociodemographic variables. Results Qom ethnicity and the number of poultry were negatively associated with surrounding NDVI, whereas overcrowding was positively associated with surrounding NDVI. Hierarchical Bayesian models identified that domestic infestation was positively associated with surrounding NDVI, suitable walls for triatomines, and overcrowding over both intervention periods. Preintervention domestic infestation also was positively associated with Qom ethnicity. Models with spatial random effects performed better than models without spatial effects. The former identified geographic areas with a domestic infestation risk not accounted for by fixed-effect variables. Conclusions Domestic infestation with T. infestans was associated with the density of green vegetation surrounding rural houses and social vulnerability over a decade of sustained vector control interventions. High density of green vegetation surrounding rural houses was associated with households with more vulnerable social conditions. Evaluation of domestic infestation risk should simultaneously consider social, landscape and spatial effects to control for their mutual dependency. Hierarchical Bayesian models provided a proficient methodology to identify areas for targeted triatomine and disease surveillance and control. Graphical Abstract

Social norms are often regarded as informal rules or strategies. Previously, we have proposed that norms are better understood as information. Social norms represent a behavioral adaptation that identifies and curates the information required to create and maintain a predictable environment. Here, we further demonstrate that social norms act as the leading edge of individual and collective search and optimization processes. These processes provide efficient and effective evolutionary mechanisms for constant adjustment and adaptation to an environment. We show that social norms constitute the forefront of our ability to ingest and process information, and are responsible for the conditions under which social and collective cognition are possible. This new model of social information processing provides not only insight into how humans adapt and evolve to diverse environments, but also provides concrete definitions of human sociality and its distinctions from that of other social animals. Our social constructs and behaviors are not separate from the physical world we inhabit, but are instead the primary means by which we exist within it.

Background: There is a gap between the number of patients waiting for a transplant and the number of kidneys available. Some deceased donor kidneys are currently nonutilized, as medical teams fear that they will experience suboptimal graft survival. However, these organs could provide an acceptable therapeutic option if they were allocated for preemptive kidney transplantation in elderly candidates. Objective: This project aims to gather patients’ perspectives on the allocation of kidneys with lower longevity for preemptive kidney transplantation in elderly patients. Design: Individual interviews. Setting: The Center hospitalier de l’Université de Montréal (CHUM) chronic kidney disease (CKD) clinic. Participants: Patients aged between 64 and 75 years with CKD G4-5 ND, followed at the CHUM and who have not initiated dialysis yet. Methods: Between March and July 2023, we conducted 14 individual interviews with patients aged between 64 and 75 years who had CKD G4-5 ND and were followed at the CHUM. The interviews were digitally recorded and transcribed. Thematic analysis was conducted. Results: Most participants were in favor of using kidneys with lower longevity to increase their access to transplantation, improve their quality of life, enable accelerated transplantation, and avoid dialysis. Patients also wanted to be engaged in the decision-making process, underlining the importance of informed consent. Although the use of kidneys with lower longevity offers the hope of returning to “normal” life, some patients were concerned about the risk of reduced graft survival and the need for a subsequent kidney transplant. In these cases, patients were interested in using mitigation strategies, such as prioritization for kidney transplantation from standard donors in case of early graft loss associated with receiving kidneys with lower longevity. They also recommended the development of a separate waiting list for patients consenting to preemptive transplantation with kidneys with lower longevity. Limitations: This study was conducted in only 1 nephrology clinic in the province of Quebec with French-speaking patients. Consequently, the results may not be generalizable to other populations, including ethnic minorities. Conclusion: The use of kidneys with lower longevity for preemptive kidney transplantation appears to be an interesting option for elderly kidney transplant candidates. However, patient information and participation in the decision-making process are essential. Moreover, organ donation organizations and transplant programs should develop a separate waitlist for transplant candidates who have preconsented to receive organ offers of deceased donor kidneys with lower longevity. Trial registration: Not registered.