Does Sex, Race, and the Size of a Kidney Transplant Candidate’s Social Network Affect the Number of Living Donor Requests? A Multicenter Social Network Analysis of Patients on the Kidney Transplant Waitlist

Gillespie, Avrum; Gardiner, Heather; Fink, Edward L.; Reese, Peter P.; Gadegbeku, Crystal A.; Obradović, Zoran

doi:10.1097/tp.0000000000003167

Cited by 19 publications

(26 citation statements)

References 33 publications

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“…In this study, 90% of African American transplant candidates had discussed LDKT with family or friends. This high prevalence of discussion occurrence is consistent with those in other studies on transplant candidates with different racial backgrounds, 6,8,13 but substantially higher than that documented in another study of waitlisted African American transplant candidates 12 . This difference may be attributed to the relatively higher levels of LDKT knowledge and interest in our study, both of which reflect a more advanced stage of LDKT readiness 12 .…”

Section: Discussionsupporting

confidence: 91%

“…We considered sociodemographic, clinical, LDKT-related, and psychosocial characteristics potentially relevant to engagement in LDKT discussions with family or friends based on their theoretical or empirical association with discussion occurrence in past studies. [6][7][8][9][10][11][12][24][25][26][27]…”

Section: Participant Characteristicsmentioning

confidence: 99%

“…The majority had Medicare coverage (53%) and a REALM-SF health literacy score consistent with at least a high school reading level (59%). The median (IQR) adult family size was six persons (4)(5)(6)(7)(8). Just over half indicated a family history of kidney disease (51%).…”

Section: Participant Characteristicsmentioning

confidence: 99%

“…5 These discussions are vital to the process of organ donation, as they increase the likelihood of finding potential donors and talking about LDKT with clinicians, each of which may lessen the need for dialysis, reduce the duration of dialysis, and decrease the wait time for a transplantable kidney. [6][7][8][9][10][11][12][13][14] Discussing LDKT with family or friends may also facilitate patients' receipt of desired or needed support for the complex treatment decisions they face, result in the recruitment of living donor champions, provide opportunities to process information and voice concerns, and benefit both physical and mental health. [13][14][15][16][17][18][19] Further, communication is a modifiable social process or behavior that can be targeted as a strategy for increasing LDKT.…”

Section: Introductionmentioning

confidence: 99%

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African Americans’ discussions about living‐donor kidney transplants with family or friends: Who, what, and why not?

DePasquale

Ellis

Sudan

et al. 2021

Clinical Transplantation

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Background: Although discussions with family or friends can improve access to livingdonor kidney transplantation (LDKT), they remain an understudied step in the LDKT process.Methods: Among 300 African American transplant candidates, we examined how sociodemographic, clinical, LDKT-related, and psychosocial characteristics related to the occurrence of LDKT discussions with family or friends. We also analyzed the relation between discussion occurrence and donor activation on transplant candidates' behalves (at least one donor inquiry or completed donor evaluation in the medical record). We assessed associations of discussion characteristics (context, content, and perceptions) with donor activation among discussants, and we identified discussion barriers among non-discussants.Results: Most candidates (90%) had discussed LDKT. Only family functioning was statistically significantly associated with discussion occurrence. Specifically, family dysfunction was associated with 62% lower odds of discussion than family function.Family functioning, discussion occurrence, and different discussion characteristics were statistically significantly related to donor activation. The most prevalent discussion barrier was never having thought about discussing LDKT.Conclusions: Family functioning affected the likelihood of discussing LDKT, and family functioning, discussion occurrence, and discussion characteristics were associated with donor activation. Advancing understanding of how family functioning and LDKT discussions affect progression to LDKT may benefit interventions to increase LDKT.

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Section: Discussionsupporting

confidence: 91%

Section: Participant Characteristicsmentioning

confidence: 99%

Section: Participant Characteristicsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

African Americans’ discussions about living‐donor kidney transplants with family or friends: Who, what, and why not?

DePasquale

Ellis

Sudan

et al. 2021

Clinical Transplantation

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“…However, women make more living donor requests than men, irrespective of race. The barrier to a living donor transplant for most women was not the size of their social support network or lack of requesting a living donor, but rather undefined factors related to the network members themselves [ 162 ].…”

Section: Resultsmentioning

confidence: 99%

A scoping review of inequities in access to organ transplant in the United States

Park

Jones

Kaplan

et al. 2022

Int J Equity Health

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Background Organ transplant is the preferred treatment for end-stage organ disease, yet the majority of patients with end-stage organ disease are never placed on the transplant waiting list. Limited access to the transplant waiting list combined with the scarcity of the organ pool result in over 100,000 deaths annually in the United States. Patients face unique barriers to referral and acceptance for organ transplant based on social determinants of health, and patients from disenfranchised groups suffer from disproportionately lower rates of transplantation. Our objective was to review the literature describing disparities in access to organ transplantation based on social determinants of health to integrate the existing knowledge and guide future research. Methods We conducted a scoping review of the literature reporting disparities in access to heart, lung, liver, pancreas and kidney transplantation based on social determinants of health (race, income, education, geography, insurance status, health literacy and engagement). Included studies were categorized based on steps along the transplant care continuum: referral for transplant, transplant evaluation and selection, living donor identification/evaluation, and waitlist outcomes. Results Our search generated 16,643 studies, of which 227 were included in our final review. Of these, 34 focused on disparities in referral for transplantation among patients with chronic organ disease, 82 on transplant selection processes, 50 on living donors, and 61 on waitlist management. In total, 15 studies involved the thoracic organs (heart, lung), 209 involved the abdominal organs (kidney, liver, pancreas), and three involved multiple organs. Racial and ethnic minorities, women, and patients in lower socioeconomic status groups were less likely to be referred, evaluated, and added to the waiting list for organ transplant. The quality of the data describing these disparities across the transplant literature was variable and overwhelmingly focused on kidney transplant. Conclusions This review contextualizes the quality of the data, identifies seminal work by organ, and reports gaps in the literature where future research on disparities in organ transplantation should focus. Future work should investigate the association of social determinants of health with access to the organ transplant waiting list, with a focus on prospective analyses that assess interventions to improve health equity.

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Neighborhood Segregation and Access to Live Donor Kidney Transplantation

Li,

Menon,

Kim

et al. 2024

JAMA Intern Med

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ImportanceIdentifying the mechanisms of structural racism, such as racial and ethnic segregation, is a crucial first step in addressing the persistent disparities in access to live donor kidney transplantation (LDKT).ObjectiveTo assess whether segregation at the candidate’s residential neighborhood and transplant center neighborhood is associated with access to LDKT.Design, Setting, and ParticipantsIn this cohort study spanning January 1995 to December 2021, participants included non-Hispanic Black or White adult candidates for first-time LDKT reported in the US national transplant registry. The median (IQR) follow-up time for each participant was 1.9 (0.6-3.0) years.Main Outcome and MeasuresSegregation, measured using the Theil H method to calculate segregation tertiles in zip code tabulation areas based on the American Community Survey 5-year estimates, reflects the heterogeneity in neighborhood racial and ethnic composition. To quantify the likelihood of LDKT by neighborhood segregation, cause-specific hazard models were adjusted for individual-level and neighborhood-level factors and included an interaction between segregation tertiles and race.ResultsAmong 162 587 candidates for kidney transplant, the mean (SD) age was 51.6 (13.2) years, 65 141 (40.1%) were female, 80 023 (49.2%) were Black, and 82 564 (50.8%) were White. Among Black candidates, living in a high-segregation neighborhood was associated with 10% (adjusted hazard ratio [AHR], 0.90 [95% CI, 0.84-0.97]) lower access to LDKT relative to residence in low-segregation neighborhoods; no such association was observed among White candidates (P for interaction = .01). Both Black candidates (AHR, 0.94 [95% CI, 0.89-1.00]) and White candidates (AHR, 0.92 [95% CI, 0.88-0.97]) listed at transplant centers in high-segregation neighborhoods had lower access to LDKT relative to their counterparts listed at centers in low-segregation neighborhoods (P for interaction = .64). Within high-segregation transplant center neighborhoods, candidates listed at predominantly minority neighborhoods had 17% lower access to LDKT relative to candidates listed at predominantly White neighborhoods (AHR, 0.83 [95% CI, 0.75-0.92]). Black candidates residing in or listed at transplant centers in predominantly minority neighborhoods had significantly lower likelihood of LDKT relative to White candidates residing in or listed at transplant centers located in predominantly White neighborhoods (65% and 64%, respectively).ConclusionsSegregated residential and transplant center neighborhoods likely serve as a mechanism of structural racism, contributing to persistent racial disparities in access to LDKT. To promote equitable access, studies should assess targeted interventions (eg, community outreach clinics) to improve support for potential candidates and donors and ultimately mitigate the effects of segregation.

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Does Sex, Race, and the Size of a Kidney Transplant Candidate’s Social Network Affect the Number of Living Donor Requests? A Multicenter Social Network Analysis of Patients on the Kidney Transplant Waitlist

Cited by 19 publications

References 33 publications

African Americans’ discussions about living‐donor kidney transplants with family or friends: Who, what, and why not?

African Americans’ discussions about living‐donor kidney transplants with family or friends: Who, what, and why not?

A scoping review of inequities in access to organ transplant in the United States

Neighborhood Segregation and Access to Live Donor Kidney Transplantation

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