Racial differences in completion of the living kidney donor evaluation process (original) (raw)
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Center-Level Factors and Racial Disparities in Living Donor Kidney Transplantation
American Journal of Kidney Diseases, 2012
Background: On average, African Americans attain living donor kidney transplantation (LDKT) at decreased rates compared with their non-African American counterparts. However, center-level variations in this disparity or the role of center-level factors is unknown. Study Design: Observational cohort study. Setting & Participants: 247,707 adults registered for first-time kidney transplants from 1995-2007 as reported by the Scientific Registry of Transplant Recipients.
Clinical Transplantation, 2011
Kidney transplantation is the renal replacement therapy of choice for end-stage renal disease (ESRD). Over the last 20 yr, the number of waitlisted candidates has increased substantially, with a relatively small increase in the deceased donor pool (1). As a result, there has been increasing need for living kidney donors. Access to living kidney donors has varied among ethnic groups in part because of differences in waitlist representation. African Americans (AA) are overrepresented in the ESRD and kidney transplant waitlist populations (29% and 34%, respectively) (1, 2), relative to their percentage within the US population (13%) (3). However, over 70% of deceased kidney donors are Caucasian (CA). Differences in the distribution of human leukocyte antigens (HLA), antibody sensitization and ABO blood types, these demographic differences often lead to prolonged deceased donor waiting times for AA as opposed to other ethnic groups (1). Despite the growing need, there is a disproportionately lower rate of live kidney donation among AA (1). Previous literature has focused primarily on ethnic differences in living donor willingness, trust in the health care system and completion of donor evaluations as reasons for the lower rates of live kidney donation in AA (4-9). Little attention has been paid to the possibility that medical Norman SP, Song PXK, Hu Y, Ojo AO. Transition from donor candidates to live kidney donors: the impact of race and undiagnosed medical disease states.
Seminars in Nephrology, 2010
One potential mechanism for reducing racial/ethnic disparities in the receipt of kidney transplants is to enhance minorities' pursuit of living donor kidney transplantation (LDKT). Pursuit of LDKT is influenced by patients' personal values, their extended social networks, the healthcare system, and the community at large. This review discusses research and interventions promoting LDKT, especially for minorities, including improving education for patients, donors, and providers, utilizing LDKT kidneys more efficiently, and reducing surgical and financial barriers to transplant. Future directions to increase awareness of LDKT for more racial/ethnic minorities are also discussed including developing culturally tailored transplant education, clarifying transplant-eligibility practice guidelines, strengthening partnerships between community kidney providers and transplant centers, and conducting general media campaigns and community outreach.
Background and objectives To reduce racial disparities in transplant, modifiable patient characteristics associated with completion of transplant evaluation and receipt of living donor kidney transplant must be identified. Design, setting, participants, & measurements From 2004 to 2007, 695 black and white patients were surveyed about 15 less-modifiable and 10 more-modifiable characteristics at evaluation onset; whether they had completed evaluation within 1 year and received living donor kidney transplants by 2010 was determined. Logistic regression and competing risks time-to-event analysis were conducted to determine the variables that predicted evaluation completion and living donor kidney transplant receipt. Results Not adjusting for covariates, blacks were less likely than whites to complete evaluation (26.2% versus 51.8%, P,0.001) and receive living donor kidney transplants (8.7% versus 21.9%, P,0.001). More-modifiable variables associated with completing evaluation included more willing to be on the waiting list (odds ratio=3.4, 95% confidence interval=2.1, 5.7), more willing to pursue living donor kidney transplant (odds ratio=2.7, 95% confidence interval=1.8, 4.0), having access to more transplant education resources (odds ratio=2.2, 95% confidence interval=1.5, 3.2), and having greater transplant knowledge (odds ratio=1.8, 95% confidence interval=1.2, 2.7). Patients who started evaluation more willing to pursue living donor kidney transplant (hazard ratio=4.3, 95% confidence interval=2.7, 6.8) and having greater transplant knowledge (hazard ratio=1.2, 95% confidence interval=1.1, 1.3) were more likely to receive living donor kidney transplants. Conclusions Because patients who began transplant evaluation with greater transplant knowledge and motivation were ultimately more successful at receiving transplants years later, behavioral and educational interventions may be very successful strategies to reduce or overcome racial disparities in transplant.
Health Disparities in Kidney Transplantation for African Americans
American journal of nephrology, 2017
The persistent challenges of bridging healthcare disparities for African Americans (AAs) in need of kidney transplantation continue to be unresolved at the national level. This healthcare disparity is multifactorial: stemming from limited kidney donors suitable for AAs; inconsistent care coordination and suboptimal risk factor control; social determinants, low socioeconomic status, reduced access to care; and mistrust of clinicians and the healthcare system. There are numerous opportunities to significantly lessen the disparities in kidney transplantation for AAs through the following measures: the adoption of new care and patient engagement models that include education, enhanced practice-level cultural sensitivity, and timely referral as well as increased research on the impact of the environment on genetic risk, and implementation of new transplantation-related policies. Key Messages: This systematic review describes pretransplant concerns related to access to kidney transplantat...
Racial Disparities in Kidney Graft Survival: Does Donor Quality Explain the Difference?
American Journal of Transplantation, 2012
Racial disparities exist in access to kidney transplantation. Despite a threefold higher rate of end stage renal disease among African Americans (AA) compared to Caucasians (1), AAs face significant barriers in access to transplant referral, waitlisting and transplantation (2). Challenges continue for AAs even after organ receipt. As highlighted in the 2010 SRTR data report, 5-year graft survival for deceased donor (DD) transplants was 74.8% (± 0.4%) for Caucasians and 66.3% (±0.5%) for AAs and these differences increase over time (1). The reasons for the disparities are unclear, and are likely multifactorial.
Racial disparities in preemptive referral for kidney transplantation in Georgia
Clinical transplantation, 2018
Racial disparities persist in access to kidney transplantation. Racial differences in preemptive referral, or referral prior to dialysis start, may explain this discrepancy. Patient-level data on kidney transplant referrals (2005-2012) from all Georgia transplant centers were linked to the United States Renal Data System to examine racial disparities in preemptive referral, waitlisting, and living donor transplant. Adjusted logistic regression and Cox proportional hazard models determined the associations between race (African American vs white) and preemptive referral, and placement on the waitlist and receipt of a living donor kidney, respectively. Among 7752 adults referred for transplant evaluation, 20.38% (n = 1580) were preemptively referred. The odds of African Americans being preemptively referred for transplant evaluation were 37% (OR = 0.63; [95% CI: 0.55 0.71]) lower than white patients. Among preemptively referred patients, there was no racial difference (African America...
Racial and ethnic disparities in kidney transplantation
Transplant International, 2010
Success of renal transplantation, as a viable alternative to dialysis, has been tempered by long-standing racial disparities. Ethnic minorities have less access to transplantation, are less likely to be listed for transplantation, and experience a higher rate of graft failure. Reasons for the existing racial disparities at various stages of the transplantation process are complex and multi-factorial. They include a combination of behavioral, social, environmental, and occupational factors, as well as potential intended or unintended discrimination within the healthcare system. Immunologic factors such as human leukocyte antigen matching, composition of the organ donor pool, and patient immune response, all of which affect post-transplantation graft rejection rates and patient survival, also contribute to health disparities between ethnic groups.