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Tamara F, Fajar JK, Susanto A, Enggriani YT, Beluan MIS, Mirino R, Farida LD, Hastutya DV, Puspitasari DA, Putri YS, Susanto JP, Dzhyvak V. Global prevalence and potential factors influencing willingness for renal transplantation in end-stage renal disease patients: A systematic review and meta- analysis. NARRA J 2024; 4:e964. [PMID: 39816085 PMCID: PMC11732001 DOI: 10.52225/narra.v4i3.903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2024] [Accepted: 08/05/2024] [Indexed: 01/18/2025]
Abstract
The prevalence of willingness to undergo renal transplantation and its potentially associated factors have been documented in multiple prior studies across different regions, yet certain findings are conflicting. The aim of this study was to determine the global prevalence of willingness for renal transplantation and identify its associated factors through meta-analysis methods. Databases such as Scopus, PubMed, and Embase were utilized for the search strategy, covering the period from April to May 2024. Data collection focused on gathering information regarding the prevalence and potential contributing factors of renal transplantation. Statistical analysis involved examining the cumulative prevalence of willingness for renal transplantation using single-arm meta- analysis. Factors associated with willingness for renal transplantation were analyzed using the Mantel-Haenszel test for categorical variables and the inverse variance method for numerical variables. A total of nine articles, covering 3935 patients with end-stage renal disease (ESRD) were included. The pooled estimates revealed that the overall prevalence of willingness to undergo renal transplantation among ESRD patients was 57% (95%CI: 0.46-0.67). Furthermore, we observed a higher likelihood of willingness among men and those of younger age, attainment of at least a bachelor's degree or higher in education, employment status, higher income levels, and a shorter duration of hemodialysis (<5 years). Our study has documented the global prevalence and potential associated factors of willingness to undergo renal transplantation, providing valuable insights for policymakers aiming to enhance the acceptance of renal transplantation.
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Affiliation(s)
- Fredo Tamara
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Negeri Sebelas Maret, Surakarta, Indonesia
| | - Jonny K. Fajar
- Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
| | - Agung Susanto
- Division of Nephrology and Hypertension, Department of Internal Medicine, Faculty of Medicine, Universitas Negeri Sebelas Maret, Surakarta, Indonesia
| | | | | | | | - Lia D. Farida
- Department of Biomedical Sciences, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
| | | | | | - Yama S. Putri
- Faculty of Medicine, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jefri P. Susanto
- Department of Internal Medicine, Dr. Ben Mboi General Hospital, Kupang, Indonesia
| | - Volodymyr Dzhyvak
- Department of Children's Diseases and Pediatric Surgery, I. Horbachevsky Ternopil National Medical University, Ternopil, Ukraine
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2
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Gumber RI, Doshi MD. Is It Time To Drop the Use of Race From Kidney Donor Risk Index Calculator? Transplantation 2024; 108:1643-1646. [PMID: 38548698 PMCID: PMC11265987 DOI: 10.1097/tp.0000000000004998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
| | - Mona D Doshi
- Department of Medicine, University of Michigan, Ann Arbor, MI
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3
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Kaplow K, Ruck JM, Levan ML, Thomas AG, Stewart D, Massie AB, Sung HC, Pisano SF, Sidoti C, Segev DL, Sinacore J, Waterman AD. National Attitudes Toward Living Kidney Donation in the United States: Results of a Public Opinion Survey. Kidney Med 2024; 6:100788. [PMID: 38435064 PMCID: PMC10906424 DOI: 10.1016/j.xkme.2023.100788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Rationale & Objective Understanding national attitudes about living kidney donation will enable us to identify and address existing disincentives to living kidney donation. We performed a national survey to describe living kidney donation perceptions, perceived factors that affect the willingness to donate, and analyzed differences by demographic subgroups. Study Design The survey items captured living kidney donation awareness, living kidney donation knowledge, willingness to donate, and barriers and facilitators to living kidney donation. Setting & Population We surveyed 802 US adults (aged 25-65 years) in June 2021, randomly selected from an online platform with diverse representation. Analytical Approach We developed summed, scaled indices to assess the association between the living kidney donation knowledge (9 items) and the willingness to donate (8 items) to self-reported demographic characteristics and other variables of interest using analysis of variance. All other associations for categorical questions were calculated using Pearson's χ2 and Fisher exact tests. We inductively evaluated free-text responses to identify additional barriers and facilitators to living kidney donation. Results Most (86.6%) of the respondents reported that they might or would definitely consider donating a kidney while they were still living. Barriers to living kidney donation included concerns about the risk of the surgery, paying for medical expenses, and potential health effects. Facilitators to living kidney donation included having information on the donation surgery's safety, knowing that the donor would not have to pay for medical expenses related to the donation, and hearing living kidney donation success stories. Awareness of the ability to participate in kidney-paired donation was associated with a higher willingness to donate. Limitations Potential for selection bias resulting from the use of survey panels and varied incentive amounts, and measurement error related to respondents' attention level. Conclusions Most people would consider becoming a living kidney donor. Increased rates of living kidney donation may be possible with investment in culturally competent educational interventions that address risks associated with donating, policies that reduce financial disincentives, and communication campaigns that raise awareness of kidney-paired donation and living kidney donation.
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Affiliation(s)
- Katya Kaplow
- Department of Surgery, New York University Langone, New York, New York
| | - Jessica M. Ruck
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Macey L. Levan
- Department of Surgery, New York University Langone, New York, New York
| | - Alvin G. Thomas
- Department of Surgery, New York University Langone, New York, New York
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Darren Stewart
- Department of Surgery, New York University Langone, New York, New York
| | - Allan B. Massie
- Department of Surgery, New York University Langone, New York, New York
| | - Hannah C. Sung
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah F. Pisano
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carolyn Sidoti
- Department of Surgery, New York University Langone, New York, New York
| | - Dorry L. Segev
- Department of Surgery, New York University Langone, New York, New York
| | | | - Amy D. Waterman
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
- Department of Surgery, J.C. Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas
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4
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Sieverdes JC, Mueller M, Nemeth LS, Patel S, Baliga PK, Treiber FA. A distance-based living donor kidney education program for Black wait-list candidates: A feasibility randomized trial. Clin Transplant 2021; 35:e14426. [PMID: 34269480 PMCID: PMC9888645 DOI: 10.1111/ctr.14426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/25/2021] [Accepted: 06/12/2021] [Indexed: 02/02/2023]
Abstract
Addressing racial disparities in living donor kidney transplants (LDKT) among Black patients warrants innovative programs to improve living donation rates. The Living Organ Video Educated Donors (LOVED) program is a 2-arm, culturally-tailored, distance-based, randomized controlled feasibility trial. The group-based, 8-week program used peer-navigator led video chat sessions and web-app video education for Black kidney waitlisted patients from United States southeastern state. Primary feasibility results for LOVED (n = 24) and usual care (n = 24) arms included LOVED program tolerability (i.e., 95.8% retention), program fidelity (i.e., 78.9% video education adherence and 72.1% video chat adherence). LDKT attitudinal and knowledge results favored the LOVED group where a statistically significant effect was reported over 6-months for willingness to approach strangers (estimate ± SE: -1.0 ± .55, F(1, 45.3) = 7.5, P = .009) and self-efficacy to advocate for a LDKT -.81 ± .31, F(1, 45.9) = 15.2, P < .001. Estimates were improved but not statistically significant for willingness to approach family and friends, LDKT knowledge and concerns for living donors (all P's > .088). Secondary measures at 6 months showed an increase in calls for LOVED compared to usual care (P = .008) though no differences were found for transplant center evaluations or LDKTs. Findings imply that LOVED increased screening calls and attitudes to approach potential donors but feasibility outcomes found program materials require modification to increase adherence.
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Affiliation(s)
- John C. Sieverdes
- College of Charleston, Department of Health and Human Performance, 24 George Street, Charleston, SC 29425-1600,Medical University of South Carolina, College of Medicine, 96 Jonathan Lucas St. Charleston, SC 29425-1600, USA
| | - Martina Mueller
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St. Charleston, SC 29425-1600, USA
| | - Lynne S. Nemeth
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St. Charleston, SC 29425-1600, USA
| | - Sachin Patel
- Medical University of South Carolina, College of Medicine, 96 Jonathan Lucas St. Charleston, SC 29425-1600, USA,Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St. Charleston, SC 29425-1600, USA
| | - Prabhakar K. Baliga
- Medical University of South Carolina, College of Medicine, 96 Jonathan Lucas St. Charleston, SC 29425-1600, USA
| | - Frank A. Treiber
- Medical University of South Carolina, College of Medicine, 96 Jonathan Lucas St. Charleston, SC 29425-1600, USA,Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St. Charleston, SC 29425-1600, USA
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Acceptability of a Mobile-Health Living Kidney Donor Advocacy Program for Black Wait-Listed Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168239. [PMID: 34443991 PMCID: PMC8393864 DOI: 10.3390/ijerph18168239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022]
Abstract
Marked racial disparities exist in rates of living donor kidney transplantation (LDKT). The Living Organ Video Educated Donors (LOVED) program is a distance-based, mobile health program designed to help Black kidney transplant wait-list patients advocate for a living donor. This study reported on the acceptability outcomes to aid in future refinements. Participants were randomized to LOVED (n = 24, mean age = 50.9 SD (9.2) years), male = 50%) and usual care groups (n = 24 (mean age 47.9 SD (10.0), male 50%). Four LOVED groups completed an eight-week intervention that consisted of six online video education modules and eight group video chat sessions led by a Black navigator. Qualitative analysis from post-study focus groups resulted in six themes: (1) video chat sessions provided essential support and encouragement, (2) videos motivated and made participants more knowledgeable, (3) connectivity with tablets was acceptable in most areas, (4) material was culturally sensitive, (5) participation was overall a positive experience and (6) participants were more willing to ask for a kidney now. The video chat sessions were pertinent in participant satisfaction, though technology concerns limited program implementation. Results showed that the LOVED program was acceptable to engage minorities in health behavior changes for living donor advocacy but barriers exist that require future refinement.
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van Dellen D, Burnapp L, Citterio F, Mamode N, Moorlock G, van Assche K, Zuidema WC, Lennerling A, Dor FJMF. Pre-emptive live donor kidney transplantation-moving barriers to opportunities: An ethical, legal and psychological aspects of organ transplantation view. World J Transplant 2021; 11:88-98. [PMID: 33954087 PMCID: PMC8058646 DOI: 10.5500/wjt.v11.i4.88] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 01/30/2021] [Accepted: 03/12/2021] [Indexed: 02/06/2023] Open
Abstract
Live donor kidney transplantation (LDKT) is the optimal treatment modality for end stage renal disease (ESRD), enhancing patient and graft survival. Pre-emptive LDKT, prior to requirement for renal replacement therapy (RRT), provides further advantages, due to uraemia and dialysis avoidance. There are a number of potential barriers and opportunities to promoting pre-emptive LDKT. Significant infrastructure is needed to deliver robust programmes, which varies based on socio-economic standards. National frameworks can impact on national prioritisation of pre-emptive LDKT and supporting education programmes. Focus on other programme’s components, including deceased kidney transplantation and RRT, can also hamper uptake. LDKT programmes are designed to provide maximal benefit to the recipient, which is specifically true for pre-emptive transplantation. Health care providers need to be educated to maximize early LDKT referral. Equitable access for varying population groups, without socio-economic bias, also requires prioritisation. Cultural barriers, including religious influence, also need consideration in developing successful outcomes. In addition, the benefit of pre-emptive LDKT needs to be emphasised, and opportunities provided to potential donors, to ensure timely and safe work-up processes. Recipient education and preparation for pre-emptive LDKT needs to ensure increased uptake. Awareness of the benefits of pre-emptive transplantation require prioritisation for this population group. We recommend an approach where patients approaching ESRD are referred early to pre-transplant clinics facilitating early discussion regarding pre-emptive LDKT and potential donors for LDKT are prioritized for work-up to ensure success. Education regarding pre-emptive LDKT should be the norm for patients approaching ESRD, appropriate for the patient’s cultural needs and physical status. Pre-emptive transplantation maximize benefit to potential recipients, with the potential to occur within successful service delivery. To fully embrace preemptive transplantation as the norm, investment in infrastructure, increased awareness, and donor and recipient support is required.
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Affiliation(s)
- David van Dellen
- Department of Renal and Pancreas Transplantation, Manchester University NHS Foundation Trust, Manchester M13 9WL, United Kingdom
- Department of Faculty of Biology, Medicine and Health, University of Manchester, Manchester M13 9PL, United Kingdom
| | - Lisa Burnapp
- Department of Transplantation, Guy's and St. Thomas' NHS Foundation Trust, London SE1 9RT, United Kingdom
| | - Franco Citterio
- Department of Surgery, Renal Transplantation, Catholic University, Rome 00153, Italy
| | - Nizam Mamode
- Department of Transplantation, Guy's and St. Thomas' NHS Foundation Trust, London SE1 9RT, United Kingdom
| | - Greg Moorlock
- Warwick Medical School, University of Warwick, Coventry CV4 7AL, United Kingdom
| | - Kristof van Assche
- Res Grp Personal Rights & Property Rights, University of Antwerp, Antwerp 2000, Belgium
| | - Willij C Zuidema
- Departments of Internal Medicine, Erasmus Medical Centre, Rotterdam CE 1015, Netherlands
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, Gothenburg S-413 45, Sweden
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg S-405 30, Sweden
| | - Frank JMF Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, London W2 1NY, United Kingdom
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7
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El-Dassouki N, Wong D, Toews DM, Gill J, Edwards B, Orchanian-Cheff A, Neves P, Marshall LJ, Mucsi I. Barriers to Accessing Kidney Transplantation Among Populations Marginalized by Race and Ethnicity in Canada: A Scoping Review Part 2-East Asian, South Asian, and African, Caribbean, and Black Canadians. Can J Kidney Health Dis 2021; 8:2054358121996834. [PMID: 33738106 PMCID: PMC7934034 DOI: 10.1177/2054358121996834] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/17/2021] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Kidney transplantation (KT), a treatment option for end-stage kidney disease (ESKD), is associated with longer survival and improved quality of life compared with dialysis. Inequities in access to KT, and specifically, living donor kidney transplantation (LDKT), have been documented in Canada, along various demographic dimensions. In this article, we review existing evidence about inequitable access to KT and LDKT for patients from communities marginalized by race and ethnicity in Canada. OBJECTIVE To characterize the currently published data on rates of KT and LDKT among East Asian, South Asian, and African, Caribbean, and Black (ACB) Canadian communities and to answer the research question, "what factors may influence inequitable access to KT among East Asian, South Asian, and ACB Canadian communities?." ELIGIBILITY CRITERIA Databases and gray literature were searched in June and November 2020 for full-text original research articles or gray literature resources addressing KT access or barriers in East Asian, South Asian, and ACB Canadian communities. A total of 25 articles were analyzed thematically. SOURCES OF EVIDENCE Gray literature and CINAHL, OVID Medline, OVID Embase, and Cochrane databases. CHARTING METHODS Literature characteristics were recorded and findings which described rates of and factors that influence access to KT were summarized in a narrative account. Key themes were subsequently identified and synthesized thematically in the review. RESULTS East Asian, South Asian, and ACB communities in Canada face barriers in accessing culturally appropriate medical knowledge and care and experience inequitable access to KT. Potential barriers include gaps in knowledge about ESKD and KT, religious and spiritual concerns, stigma of ESKD and KT, health beliefs, social determinants of health, and experiences of systemic racism in health care. LIMITATIONS This review included literature that used various methodologies and did not assess study quality. Data on ethnicity and race were not reported or defined in a standardized manner. The communities examined in this review are not homogeneous and views on organ donation and KT vary by individual. CONCLUSIONS Our review has identified potential barriers for communities marginalized by race and ethnicity in accessing KT and LDKT. Further research is urgently needed to better understand the barriers and support needs of these communities, and to develop strategies to improve equitable access to LDKT for the growingly diverse population in Canada.
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Affiliation(s)
- Noor El-Dassouki
- Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Dorothy Wong
- Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Deanna M. Toews
- Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Jagbir Gill
- The University of British Columbia, Vancouver, Canada
| | - Beth Edwards
- Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Ani Orchanian-Cheff
- Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Paula Neves
- Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Lydia-Joi Marshall
- Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
| | - Istvan Mucsi
- Ajmera Transplant Centre, Toronto General Hospital, University Health Network, Toronto, ON, Canada
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8
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Kearney J, Smith P, Elias R, Bramham K. Assessment of Barriers to Donation for Potential Black Kidney Donors. Kidney Int Rep 2020; 6:493-495. [PMID: 33615074 PMCID: PMC7879095 DOI: 10.1016/j.ekir.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 10/20/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Jessica Kearney
- King's Kidney Care, Kings College Hospital NHS Foundation Trust, London, UK
| | - Priscilla Smith
- King's Kidney Care, Kings College Hospital NHS Foundation Trust, London, UK
| | - Rob Elias
- King's Kidney Care, Kings College Hospital NHS Foundation Trust, London, UK
| | - Kate Bramham
- King's Kidney Care, Kings College Hospital NHS Foundation Trust, London, UK.,Department of Women and Children's Health, King's College London, London, UK
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9
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Bongiovanni T, Rawlings JE, Trompeta JA, Nunez-Smith M. Cultural influences on willingness to donate organs among urban native Americans. Clin Transplant 2020; 34:e13804. [PMID: 31999875 DOI: 10.1111/ctr.13804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 01/23/2020] [Accepted: 01/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The need for organ donation is substantial among Native Americans, driven by the disproportionate burden of ESRD. Due to the dearth of knowledge about willingness to donate (WTD) among urban Native Americans, a group that represents over half of the US Native population, we aimed to examine factors affecting donation. METHODS We conducted a cross-sectional survey of a convenience sample, using a questionnaire developed specifically for this study using community-based participatory research. The questionnaire was designed to be culturally relevant to the Native community, based on questions from three previously validated instruments and developed through one-on-one interviews. We performed logistic regression to associate survey answers with WTD. RESULTS Seventy percent of our 183 respondents stated that they would be willing to have their organs donated after death; however, only 41% were already registered as an organ donor on their driver's license. Logistic regression analysis found specific items in domains of trust of the medical community and spirituality most closely associated with WTD. Sixty-two percent of Native Americans surveyed reported they would not donate organs because they distrust the medical community. DISCUSSION Our findings suggest multiple areas of focus for increasing organ donation within this subset of the diverse Native community. Efforts to promote donation should be aimed at building trust in the medical community.
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Affiliation(s)
- Tasce Bongiovanni
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, California.,Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut.,U.S. Department of Veterans Affairs, Connecticut Healthcare System, West Haven, Connecticut
| | | | - Joyce A Trompeta
- Department of Surgery, University of California San Francisco School of Medicine, San Francisco, California
| | - Marcella Nunez-Smith
- Department of Internal Medicine, Equity Research and Innovation Center, Yale University School of Medicine, New Haven, Connecticut
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Ku E, Yang W, McCulloch CE, Feldman HI, Go AS, Lash J, Bansal N, He J, Horwitz E, Ricardo AC, Shafi T, Sondheimer J, Townsend RR, Waikar SS, Hsu CY. Race and Mortality in CKD and Dialysis: Findings From the Chronic Renal Insufficiency Cohort (CRIC) Study. Am J Kidney Dis 2019; 75:394-403. [PMID: 31732235 DOI: 10.1053/j.ajkd.2019.08.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/02/2019] [Indexed: 01/13/2023]
Abstract
RATIONALE & OBJECTIVES Few studies have investigated racial disparities in survival among dialysis patients in a manner that considers risk factors and mortality during the phase of kidney disease before maintenance dialysis. Our objective was to explore racial variations in survival among dialysis patients and relate them to racial differences in comorbid conditions and rates of death in the setting of kidney disease not yet requiring dialysis therapy. STUDY DESIGN Retrospective cohort study. SETTINGS & PARTICIPANTS 3,288 black and white participants in the Chronic Renal Insufficiency Cohort (CRIC), none of whom were receiving dialysis at enrollment. EXPOSURE Race. OUTCOME Mortality. ANALYTIC APPROACH Cox proportional hazards regression was used to examine the association between race and mortality starting at: (1) time of dialysis initiation and (2) entry into the CRIC. RESULTS During 7.1 years of median follow-up, 678 CRIC participants started dialysis. Starting from the time of dialysis initiation, blacks had lower risk for death (unadjusted HR, 0.67; 95% CI, 0.51-0.87) compared with whites. Starting from baseline CRIC enrollment, the strength of the association between some risk factors and dialysis was notably stronger for whites than blacks. For example, the HR for dialysis onset in the presence (vs absence) of heart failure at CRIC enrollment was 1.30 (95% CI, 1.01-1.68) for blacks versus 2.78 (95% CI, 1.90-4.50) for whites, suggesting differential severity of these risk factors by race. When we included deaths occurring both before and after dialysis, risk for death was higher among blacks (vs whites) starting from CRIC enrollment (HR, 1.41; 95% CI, 1.22-1.64), but this finding was attenuated in adjusted models (HR, 1.08; 95% CI, 0.91-1.28). LIMITATIONS Residual confounding. CONCLUSIONS The apparent survival advantage among blacks over whites treated with dialysis may be attributed to selected transition of a subset of whites with more severe comorbid conditions onto dialysis.
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Affiliation(s)
- Elaine Ku
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA; Division of Pediatric Nephrology, Department of Pediatrics, University of California San Francisco, San Francisco, CA.
| | - Wei Yang
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA
| | - Harold I Feldman
- Division of Nephrology, Department of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Alan S Go
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA; Division of Research, Kaiser Permanente Northern California, San Francisco, CA
| | - James Lash
- Division of Nephrology, Department of Medicine, University of Illinois, Chicago, IL
| | - Nisha Bansal
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Jiang He
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| | - Ed Horwitz
- Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland OH
| | - Ana C Ricardo
- Division of Nephrology, Department of Medicine, University of Illinois, Chicago, IL
| | - Tariq Shafi
- Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD
| | | | - Raymond R Townsend
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sushrut S Waikar
- Division of Nephrology, Department of Medicine, Brigham and Women's Hospital, Boston, MA; Renal Section, Department of Medicine, Boston University Medical Center, Boston, MA
| | - Chi-Yuan Hsu
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA
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11
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Kumar K, Tonascia JM, Muzaale AD, Purnell TS, Ottmann SE, Al Ammary F, Bowring MG, Poon A, King EA, Massie AB, Chow EKH, Thomas AG, Ying H, Borja M, Konel JM, Henderson M, Cameron AM, Garonzik-Wang JM, Segev DL. Racial differences in completion of the living kidney donor evaluation process. Clin Transplant 2018; 32:e13291. [PMID: 29791039 PMCID: PMC6398948 DOI: 10.1111/ctr.13291] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2018] [Indexed: 12/14/2022]
Abstract
Racial disparities in living donor kidney transplantation (LDKT) persist but the most effective target to eliminate these disparities remains unknown. One potential target could be delays during completion of the live donor evaluation process. We studied racial differences in progression through the evaluation process for 247 African American (AA) and 664 non-AA living donor candidates at our center between January 2011 and March 2015. AA candidates were more likely to be obese (38% vs 22%: P < .001), biologically related (66% vs 44%: P < .001), and live ≤50 miles from the center (64% vs 37%: P < .001) than non-AAs. Even after adjusting for these differences, AAs were less likely to progress from referral to donation (aHR for AA vs non-AA: 0.26 0.47 0.83; P = .01). We then assessed racial differences in completion of each step of the evaluation process and found disparities in progression from medical screening to in-person evaluation (aHR: 0.41 0.620.94; P = .02) and from clearance to donation (aHR: 0.28 0.510.91; P = .02), compared with from referral to medical screening (aHR: 0.78 1.021.33; P = .95) and from in-person evaluation to clearance (aHR: 0.59 0.931.44; P = .54). Delays may be a manifestation of the transplant candidate's social network, thus, targeted efforts to optimize networks for identification of donor candidates may help address LDKT disparities.
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Affiliation(s)
- Komal Kumar
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James M Tonascia
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Abimereki D Muzaale
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Tanjala S Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Shane E Ottmann
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fawaz Al Ammary
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Mary G Bowring
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Anna Poon
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth A King
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Eric K H Chow
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Hao Ying
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Marvin Borja
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jonathan M Konel
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Macey Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Andrew M Cameron
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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12
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Boima V, Ganu V, Dey D, Yorke E, Yawson A, Otchere Y, Nartey S, Gyaban-Mensah A, Lartey M, Mate-Kole CC. Kidney transplantation in Ghana: Is the public ready? Clin Transplant 2017; 31. [PMID: 28748575 DOI: 10.1111/ctr.13061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND The burden of end stage renal disease (ESRD) is reported to be higher among people of African ancestry. The majority do not have access to kidney transplantation. Africans, in general, are less likely to donate a kidney or receive a transplant. AIMS This study surveyed public perceptions of kidney transplantation in an inner city and suburban communities in Ghana. It examined people's willingness to either accept or donate a kidney to save a life. In addition, it evaluated factors that influenced their opinion on the issue. METHODS A cross-sectional survey was conducted in five purposively selected communities in the Greater Accra region in Ghana. Structured questionnaires and standardized instruments were administered to assess participants' socio-demographic characteristics, religiosity and spirituality, and perception of kidney transplantation. RESULTS Of the 480 participants, 233 (48.5%) were willing to donate a kidney; 71.6% would only do so after death. Religion, loss of body part, and cultural values influenced participants' willingness to donate a kidney. Uncertainty of health status post-transplantation and uneasiness with the concept of transplantation influenced the participants' willingness to accept a kidney transplant. CONCLUSION The study revealed that almost half of the participants hold positive views toward kidney transplantation.
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Affiliation(s)
- Vincent Boima
- Departments of Medicine & Psychiatry, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Vincent Ganu
- Department of Medicine, Korle-Bu Teaching hospital, Accra, Ghana
| | - Dzifa Dey
- Departments of Medicine & Psychiatry, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Ernest Yorke
- Departments of Medicine & Psychiatry, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Alfred Yawson
- Department of Community Health, School of Public Heealth, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Yvonne Otchere
- Department of Psychology, Lancaster University, Accra, Ghana
| | - Stella Nartey
- Department of Psychology, College of Humanities, University of Ghana, Legon, Ghana
| | - Anna Gyaban-Mensah
- Department of Psychology, College of Humanities, University of Ghana, Legon, Ghana
| | - Margaret Lartey
- Departments of Medicine & Psychiatry, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Charles C Mate-Kole
- Departments of Medicine & Psychiatry, School of Medicine and Dentistry, College of Health Sciences, University of Ghana, Accra, Ghana.,Department of Psychology, College of Humanities, University of Ghana, Legon, Ghana
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13
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Sieverdes JC, Price M, Ruggiero KJ, Baliga PK, Chavin KD, Brunner-Jackson B, Patel S, Treiber FA. Design and approach of the Living Organ Video Educated Donors (LOVED) program to promote living kidney donation in African Americans. Contemp Clin Trials 2017; 61:55-62. [PMID: 28687348 DOI: 10.1016/j.cct.2017.07.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 07/03/2017] [Accepted: 07/03/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE To describe the rationale, methodology, design, and interventional approach of a mobile health education program designed for African Americans with end stage renal disease (ESRD) to increase knowledge and self-efficacy to approach others about their need for a living donor kidney transplant (LDKT). METHODS The Living Organ Video Educated Donors (LOVED) program is a theory-guided iterative designed, mixed methods study incorporating three phases: 1) a formative evaluation using focus groups to develop program content and approach; 2) a 2-month proof of concept trial (n=27) to primarily investigate acceptability, tolerability and investigate increases of LDKT knowledge and self-efficacy; and 3) a 6-month, 2-arm, 60-person feasibility randomized control trial (RCT) to primarily investigate increases in LDKT knowledge and self-efficacy, and secondarily, to increase the number of living donor inquiries, medical evaluations, and LDKTs. The 8-week LOVED program includes an interactive web-based app delivered on 10″ tablet computer incorporating weekly interactive video education modules, weekly group video chat sessions with an African American navigator who has had LDKT and other group interactions for support and improve strategies to promote their need for a kidney. RESULTS Phase 1 and 2 have been completed and the program is currently enrolling for the feasibility RCT. Phase 2 experienced 100% retention rates with 91% adherence completing the video modules and 88% minimum adherence to the video chat sessions. CONCLUSIONS We are in the early stages of an RCT to evaluate the LOVED program; to date, we have found high tolerability reported from Phase 2.
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Affiliation(s)
- John C Sieverdes
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
| | - Matthew Price
- University of Vermont, College of Arts and Sciences, Department of Psychological Science, John Dewey Hall, Rm 248 2 Colchester Avenue, Burlington, VT 05405-0134, USA.
| | - Kenneth J Ruggiero
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
| | - Prabhakar K Baliga
- Medical University of South Carolina, College of Medicine, 96 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
| | - Kenneth D Chavin
- Medical University of South Carolina, College of Medicine, 96 Jonathan Lucas St., Charleston, SC 29425-1600, USA; Case Western Reserve University School of Medicine, Department of Surgery-Transplant, 11100 Euclid Ave, Cleveland, OH 44106, USA.
| | - Brenda Brunner-Jackson
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
| | - Sachin Patel
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
| | - Frank A Treiber
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St., Charleston, SC 29425-1600, USA; Medical University of South Carolina, College of Medicine, 96 Jonathan Lucas St., Charleston, SC 29425-1600, USA.
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14
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Ethnic Background Is a Potential Barrier to Living Donor Kidney Transplantation in Canada: A Single-Center Retrospective Cohort Study. Transplantation 2017; 101:e142-e151. [PMID: 28207634 DOI: 10.1097/tp.0000000000001658] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND We examined if African or Asian ethnicity was associated with lower access to kidney transplantation (KT) in a Canadian setting. METHODS Patients referred for KT to the Toronto General Hospital from January 1, 2003, to December 31, 2012, who completed social work assessment, were included (n = 1769). The association between ethnicity and the time from referral to completion of KT evaluation or receipt of a KT were examined using Cox proportional hazards models. RESULTS About 54% of the sample was white, 13% African, 11% East Asian, and 11% South Asian; 7% had "other" (n = 121) ethnic background. African Canadians (hazard ratio [HR], 0.75; 95% CI: 0.62-0.92]) and patients with "other" ethnicity (HR, 0.71; 95% CI, 0.55-0.92) were less likely to complete the KT evaluation compared with white Canadians, and this association remained statistically significant in multivariable adjusted models. Access to KT was significantly reduced for all ethnic groups assessed compared with white Canadians, and this was primarily driven by differences in access to living donor KT. The adjusted HRs for living donor KT were 0.35 (95% CI, 0.24-0.51), 0.27 (95% CI, 0.17-0.41), 0.43 (95% CI, 0.30-0.61), and 0.34 (95% CI, 0.20-0.56) for African, East or South Asian Canadians and for patients with "other" ethnic background, respectively. CONCLUSIONS Similar to other jurisdictions, nonwhite patients face barriers to accessing KT in Canada. This inequity is very substantial for living donor KT. Further research is needed to identify if these inequities are due to potentially modifiable barriers.
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15
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Waterman AD, Robbins ML, Peipert JD. Educating Prospective Kidney Transplant Recipients and Living Donors about Living Donation: Practical and Theoretical Recommendations for Increasing Living Donation Rates. CURRENT TRANSPLANTATION REPORTS 2016; 3:1-9. [PMID: 27347475 PMCID: PMC4918088 DOI: 10.1007/s40472-016-0090-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A promising strategy for increasing living donor kidney transplant (LDKT) rates is improving education about living donation for both prospective kidney transplant recipients and living donors to help overcome the proven knowledge, psychological, and socioeconomic barriers to LDKT. A recent Consensus Conference on Best Practices in Live Kidney Donation recommended that comprehensive LDKT education be made available to patients at all stages of chronic kidney disease (CKD). However, in considering how to implement this recommendation across different healthcare learning environments, the current lack of available guidance regarding how to design, deliver, and measure the efficacy of LDKT education programs is notable. In the current article, we provide an overview of how one behavior change theory, the Transtheoretical Model of Behavior Change, can guide the delivery of LDKT education for patients at various stages of CKD and readiness for LDKT. We also discuss the importance of creating educational programs for both potential kidney transplant recipients and living donors, and identify key priorities for educational research to reduce racial disparities in LDKT and increase LDKT rates.
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Affiliation(s)
- Amy D. Waterman
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA 90024, USA
| | | | - John D. Peipert
- Division of Nephrology, David Geffen School of Medicine, University of California Los Angeles, 10940 Wilshire Blvd, Suite 1223, Los Angeles, CA 90024, USA
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16
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Strigo TS, Ephraim PL, Pounds I, Hill-Briggs F, Darrell L, Ellis M, Sudan D, Rabb H, Segev D, Wang NY, Kaiser M, Falkovic M, Lebov JF, Boulware LE. The TALKS study to improve communication, logistical, and financial barriers to live donor kidney transplantation in African Americans: protocol of a randomized clinical trial. BMC Nephrol 2015; 16:160. [PMID: 26452366 PMCID: PMC4600221 DOI: 10.1186/s12882-015-0153-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
Background Live donor kidney transplantation (LDKT), an optimal therapy for many patients with end-stage kidney disease, is underutilized, particularly by African Americans. Potential recipient difficulties initiating and sustaining conversations about LDKT, identifying willing and medically eligible donors, and potential donors’ logistical and financial hurdles have been cited as potential contributors to race disparities in LDKT. Few interventions specifically targeting these factors have been tested. Methods/Design We report the protocol of the Talking about Living Kidney Donation Support (TALKS) study, a study designed to evaluate the effectiveness of behavioral, educational and financial assistance interventions to improve access to LDKT among African Americans on the deceased donor kidney transplant recipient waiting list. We adapted a previously tested educational and social worker intervention shown to improve consideration and pursuit of LDKT among patients and their family members for its use among patients on the kidney transplant waiting list. We also developed a financial assistance intervention to help potential donors overcome logistical and financial challenges they might face during the pursuit of live kidney donation. We will evaluate the effectiveness of these interventions by conducting a randomized controlled trial in which patients on the deceased donor waiting list receive 1) usual care while on the transplant waiting list, 2) the educational and social worker intervention, or 3) the educational and social worker intervention plus the option of participating in the financial assistance program. The primary outcome of the randomized controlled trial will measure potential recipients’ live kidney donor activation (a composite rate of live donor inquiries, completed new live donor evaluations, or live kidney donation) at 1 year. Discussion The TALKS study will rigorously assess the effectiveness of promising interventions to reduce race disparities in LDKT. Trial registration NCT02369354.
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Affiliation(s)
- Tara S Strigo
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, 27701, USA.
| | - Patti L Ephraim
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health and Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD, USA.
| | - Iris Pounds
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, 27701, USA.
| | - Felicia Hill-Briggs
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institution and Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Linda Darrell
- Department of Social Work, Morgan State University, Baltimore, MD, USA.
| | - Matthew Ellis
- Division of Nephrology, Duke University School of Medicine, Durham, NC, USA.
| | - Debra Sudan
- Division of Transplantation, Duke University School of Medicine, Durham, NC, USA.
| | - Hamid Rabb
- Division of Nephrology, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Dorry Segev
- Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Nae-Yuh Wang
- Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institution and Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Mary Kaiser
- Division of Transplantation, Johns Hopkins School of Medicine, Baltimore, MD, USA.
| | - Margaret Falkovic
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, 27701, USA.
| | - Jill F Lebov
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, 27701, USA.
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, 27701, USA.
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17
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Sieverdes JC, Nemeth LS, Magwood GS, Baliga PK, Chavin KD, Ruggiero KJ, Treiber FA. African American kidney transplant patients' perspectives on challenges in the living donation process. Prog Transplant 2015; 25:164-75. [PMID: 26107278 PMCID: PMC4929989 DOI: 10.7182/pit2015852] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT The increasing shortage of deceased donor kidneys suitable for African Americans highlights the critical need to increase living donations among African Americans. Little research has addressed African American transplant recipients' perspectives on challenges and barriers related to the living donation process. OBJECTIVE To understand the perspectives of African American recipients of deceased and living donor kidney transplants on challenges, barriers, and educational needs related to pursuing such transplants. PARTICIPANTS AND DESIGN A mixed-method design involved 27 African American kidney recipients (13 male) in 4 focus groups (2 per recipient type: 16 African American deceased donor and 11 living donor recipients) and questionnaires. Focus group transcripts were evaluated with NVivo 10.0 (QSR, International) by using inductive and deductive qualitative methods along with crystallization to develop themes of underlying barriers to the living donor kidney transplant process and were compared with the questionnaires. RESULTS Four main themes were identified from groups: concerns, knowledge and learning, expectations of support, and communication. Many concerns for the donor were identified (eg, process too difficult, financial burden, effect on relationships). A general lack of knowledge about the donor process and lack of behavioral skills on how to approach others was noted. The latter was especially evident among deceased donor recipients. Findings from the questionnaires on myths and perceptions supported the lack of knowledge in a variety of domains, including donors' surgical outcomes risks, costs of surgery, and impact on future health. Participants thought that an educational program led by an African American recipient of a living donor kidney transplant, including practice in approaching others, would increase the likelihood of transplant-eligible patients pursuing living donor kidney transplant.
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Affiliation(s)
- John C Sieverdes
- Medical University of South Carolina, Charleston (JCS, LSN, GSM, PKB, KDC, KJR, FAT), Ralph H. Johnson VA Medical Center, Charleston, South Carolina (KJR)
| | - Lynne S Nemeth
- Medical University of South Carolina, Charleston (JCS, LSN, GSM, PKB, KDC, KJR, FAT), Ralph H. Johnson VA Medical Center, Charleston, South Carolina (KJR)
| | - Gayenell S Magwood
- Medical University of South Carolina, Charleston (JCS, LSN, GSM, PKB, KDC, KJR, FAT), Ralph H. Johnson VA Medical Center, Charleston, South Carolina (KJR)
| | - Prabhakar K Baliga
- Medical University of South Carolina, Charleston (JCS, LSN, GSM, PKB, KDC, KJR, FAT), Ralph H. Johnson VA Medical Center, Charleston, South Carolina (KJR)
| | - Kenneth D Chavin
- Medical University of South Carolina, Charleston (JCS, LSN, GSM, PKB, KDC, KJR, FAT), Ralph H. Johnson VA Medical Center, Charleston, South Carolina (KJR)
| | - Ken J Ruggiero
- Medical University of South Carolina, Charleston (JCS, LSN, GSM, PKB, KDC, KJR, FAT), Ralph H. Johnson VA Medical Center, Charleston, South Carolina (KJR)
| | - Frank A Treiber
- Medical University of South Carolina, Charleston (JCS, LSN, GSM, PKB, KDC, KJR, FAT), Ralph H. Johnson VA Medical Center, Charleston, South Carolina (KJR)
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18
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Rodrigue JR, Leishman R, Vishnevsky T, Evenson A, Mandelbrot DA. Concerns of ABO incompatible and crossmatch-positive potential donors and recipients about participating in kidney exchanges. Clin Transplant 2015; 29:233-41. [PMID: 25581082 DOI: 10.1111/ctr.12509] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2015] [Indexed: 01/29/2023]
Abstract
Kidney paired exchanges (KPEs) have increased, yet are still underutilized. This study aimed to develop tools for assessing KPE concerns, identify predictors of KPE concerns, and describe common KPE concerns among potential living donors (LDs) and intended recipients. Incompatible former potential LDs (n = 135) and intended recipients (n = 83) retrospectively completed questionnaires to assess KPE concerns. Healthcare system distrust also was assessed. A minority (n = 48 or 36.5% of potential LDs; n = 25 or 30.1% of intended recipients) had pursued KPE participation. Of those who pursued KPE participation, 11 (22.9%) and 6 (24.0%) completed KPE donation or transplantation, respectively. The questionnaires for potential LDs and recipients showed good internal consistency and preliminary convergent validity. LDs and patients less willing to pursue KPE reported more KPE concerns. Common KPE concerns for both potential LDs and recipients were related to perceived Distrust/Inequity and Inconvenience/Cost. Multivariate predictors of more KPE concerns were as follows: male gender (t = 4.5, p < 0.001) and more healthcare system distrust (t = 2.5, p = 0.01) for potential LDs; black race (t = 2.1, p = 0.04) and more healthcare system distrust (t = 2.3, p = 0.03) for intended recipients. These findings underscore the importance of addressing concerns potential LDs and patients have about KPE if the true potential of KPE is to be realized.
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Affiliation(s)
- James R Rodrigue
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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