Education for pretransplant, solid-organ recipient candidates aims to improve knowledge and understanding about the transplant process, outcomes, and potential complications to support informed, shared decision-making to reduce fears and anxieties about transplant, inform expectations, and facilitate adjustment to posttransplant life. In this review, we summarize novel pretransplant initiatives and approaches to educate solid-organ transplant recipient candidates. First, we review approaches that may be common to all solid-organ transplants, then we summarize interventions specific to kidney, liver, lung, and heart transplant. We describe evidence that emphasizes the need for multidisciplinary approaches to transplant education. We also summarize initiatives that consider online (eHealth) and mobile (mHealth) solutions. Finally, we highlight education initiatives that support racialized or otherwise marginalized communities to improve equitable access to solid-organ transplant. A considerable amount of work has been done in solid-organ transplant since the early 2000s with promising results. However, many studies on education for pretransplant recipient candidates involve relatively small samples and nonrandomized designs and focus on short-term surrogate outcomes. Overall, many of these studies have a high risk of bias. Frequently, interventions assessed are not well characterized or they are combined with administrative and data-driven initiatives into multifaceted interventions, which makes it difficult to assess the impact of the education component on outcomes. In the future, well-designed studies rigorously assessing well-defined surrogate and clinical outcomes will be needed to evaluate the impact of many promising initiatives.

Background and Aims Kidney transplant (KT) is the best treatment for many patients with kidney failure. However, patients from racialized communities are less likely to receive KT. Gaps in transplant-related knowledge may be one of the potential reasons for the observed inequities in accessing KT. Here we compare patient characteristics and KT-related knowledge between South Asian (SA) versus white Canadians with kidney failure using the “Knowledge Assessment of Renal Transplantation” (KART) questionnaire. Method Secondary analysis of data from a cross-sectional convenience sample of white and SA adults with kidney failure. Sociodemographic data, self-reported information about racialized status and KART score were collected through electronic data capture. The association between racialized status and participant demographics were assessed using ANOVA, Kruskal–Wallis test or chi squared test, as appropriate. The independent association between racialized status and KART scores was assessed by multivariable adjusted linear or multinomial logistic regression, with adjustment for immigration status, age, marital status, education, gender, Ontario Marginalization Index material deprivation quintile, Charlson Comorbidity Index and ethnicity. Results Among 578 participants (mean [SD] age: 57 [14] years, 64% male), 43% were white and 16% were SA. 84% vs 27% of SA vs white participants were immigrants. The Charlson Comorbidity Index score was >=4 for of 31[40%] SA vs 105[51%] white participants (p<0.001). The median (interquartile range) KART score of white vs SA participants was 17[6] vs 14[7] (p<0.001). In a univariable linear regression model the KART score was significantly associated with SA status (B: -3.27 ([95% CI]: -4.76, -1.77, p<0.001). This association remained significant after adjustment for potential confounding (B: -3.36 ([95% CI]: -5.05, -1.67, p<0.001) (Table 1). 26% of SA vs. 41% of white participants scored in the highest tertile for KART score (p<0.001) (Fig. 1). The relative risk ratio to be in the lowest KART tertile was 3.09 [95% CI: 1.49, 6.43] for SA compared to white participants in our final, adjusted multinomial model. Conclusion SA participants with kidney failure are commonly immigrants who have poorer KT-related knowledge compared to white participants. Our findings indicate the need to develop culturally relevant KT related patient education for South Asian Canadian communities.