AUTHOR=Holland J. A. , Partridge J. S. L , Thom R. L. , Raburn I. , Summers D. M. , Ruck Keene A. , Bunnik E. M. M., Cronin A. J. 
  
TITLE=Assessing and cataloguing cognitive impairment in older potential kidney transplant patients: key recommendations from the ethical and legal issues working group of ELPAT
  
JOURNAL=Transplant International
  
VOLUME=Volume 39 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/transplant-international/articles/10.3389/ti.2026.16770
  
DOI=10.3389/ti.2026.16770
  
ISSN=1432-2277
  
ABSTRACT=Cognitive impairment is common in older patients with advanced kidney disease and may influence access to and outcomes from kidney transplantation. However, its assessment and documentation within transplant evaluation remain inconsistent, with important ethical and legal implications. This position paper from the Ethical and Legal Issues Working Group of ELPAT synthesises current evidence, ethical and legal frameworks, and findings from a UK-wide national survey to propose a structured approach to the assessment and documentation of cognitive impairment in older potential kidney transplant recipients. Survey data demonstrate substantial variability in screening practices, documentation, and capacity assessment during transplant workup, contrasting with the standardised evaluation of other transplant domains. Cognitive impairment may affect decision-making capacity, perioperative risk, post-transplant self-management, and graft outcomes, raising important ethical considerations regarding autonomy, equity, and resource allocation. We recommend routine screening using validated tools, standardised documentation within clinical records and registries, use of these data to inform policy and research, prioritisation of cognitive outcomes in future studies, and targeted education and training in cognitive and capacity assessment. Embedding these measures within transplant pathways will support equitable access, informed decision-making, and improved outcomes.