Shared Decision-making Model for Solid Organ Transplant Recipients during Ramadan Fasting

Fasting during the month of Ramadan is an obligatory religious practice for healthy adult Muslims. To complete a fast, individuals must abstain from eating, drinking, and taking medications from dawn to sunset. Individuals may be exempt from fasting during Ramadan on health grounds. However, some patients may still fast to fulfill their religious obligation, even if this means going against medical advice. Solid organ transplant recipients may have to follow strict fluid and electrolyte requirements, which could be challenging during Ramadan, leading to the concern that abstaining from fluid intake can lead to prerenal acute kidney injury. Furthermore, transplant recipients must take their immunosuppression at prescribed intervals to preserve graft function, drug level variability runs the risk of graft rejection. Following a review of the current literature, a shared decision-making tool has been developed to assist clinicians in supporting patients who are motivated to fast during Ramadan. All recipients wishing to fast should undergo a risk assessment. Those in the low–moderate risk category may be able to fast and safely follow medication reviews and optimize their immunosuppression regimens. In addition, they would benefit from monitoring graft function, therapeutic drug levels, electrolytes, and additional parameters such as fluid status, weight, blood pressure, and concurrent management of comorbidities. Those stratified in the higher-risk categories should be encouraged to explore alternatives, such as Fidyah or winter fasting.