Increasing Live Donor Kidney Transplantation: A Randomized Controlled Trial of a Home-Based Educational Intervention

Rodrigue, James R.; Cornell, Danielle L.; Lin, Jiongtong; Kaplan, Bruce; Howard, Richard J.

doi:10.1111/j.1600-6143.2006.01623.x

Cited by 181 publications

(199 citation statements)

References 30 publications

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“…This need for a more active approach has been identified in the literature (27,28). This study is complementary to the earlier study on home-based education (15). The main extension of our intervention is the inclusion of only those patients who have not previously been able to find a living donor.…”

Section: Discussionsupporting

confidence: 60%

“…In response, a home-based intervention has been developed (15). The results showed superior effects for the home-based education compared with standard hospitaleducation in terms of higher knowledge, more communication with others regarding LDKT and fewer concerns toward LDKT (15). Additionally, there was a significant increase in the number of living donor inquiries, living donor evaluations and LDKTs performed in the home-based education group.…”

Section: Introductionmentioning

confidence: 87%

“…To determine an adequate sample size for detecting the effect, we did a power analysis based on the primary outcomes found in previous research (15,16). The knowledge parameter shows a large effect size that would result in a very low sample size, whereas self-efficacy would require a larger sample size.…”

Section: Sample Size Calculationmentioning

confidence: 99%

“…This health care inequality, for ethnic minorities and individuals who find it hard to discuss living donation, needs to be addressed (14). In response, a home-based intervention has been developed (15). The results showed superior effects for the home-based education compared with standard hospitaleducation in terms of higher knowledge, more communication with others regarding LDKT and fewer concerns toward LDKT (15).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Home-Based Family Intervention Increases Knowledge, Communication and Living Donation Rates: A Randomized Controlled Trial

Ismail

Luchtenburg

Timman

et al. 2014

American Journal of Transplantation

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Section: Discussionsupporting

confidence: 60%

Section: Introductionmentioning

confidence: 87%

Section: Sample Size Calculationmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Home-Based Family Intervention Increases Knowledge, Communication and Living Donation Rates: A Randomized Controlled Trial

Ismail

Luchtenburg

Timman

et al. 2014

American Journal of Transplantation

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“…These programs also should facilitate discussions on kidney donation between patients and their families. Such strategies have proven successful at increasing ESRD patients' access to LDKT (43,44). Interventions examining the impact of financial disincentives on access to preemptive transplantation should be considered.…”

Section: Discussionmentioning

confidence: 99%

A Survey of Nephrologists’ Views on Preemptive Transplantation

Pradel

Jain

Mullins

et al. 2008

Clinical Journal of the American Society of Nephrology

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Background and objectives: Despite emerging evidence that preemptive transplantation is the best treatment modality for patients reaching end-stage renal disease (ESRD), it is underutilized. Nephrologists' views on preemptive transplantation are explored herein.Design, setting, participants, & measurements: A web-based survey elicited barriers to preemptive transplantation as perceived by nephrologists as well as demographic and practice variables associated with a favorable attitude toward preemptive transplantation.Results: Four hundred seventy-six of 5,901 eligible nephrologists responded (8% participation rate). Seventy-one percent of respondents agreed that preemptive transplantation is the best treatment modality for eligible chronic kidney disease (CKD) patients reaching ESRD, 69% reported that late referrals did not allow enough time for patients to be evaluated for preemptive transplantation, and 50% stated that there was too much delay between a patient's referral and the time the patient was seen at the transplant center. Nephrologists agreed to a lesser extent that they should be held accountable for CKD patients' education (26%) and preemptive transplant referrals (23%). The most important patient factors considered when deciding not to discuss preemptive transplant were poor health status (70%), lack of compliance (69%), other medical problems (51%), being too old (40%), lack of prescription coverage (37%), and lack of health insurance to cover the costs of the procedure (36%).Conclusions: Surveyed nephrologists consider preemptive transplantation as the optimal treatment modality for eligible patients. Late referral, patient health and insurance status, and delayed transplant center evaluation are perceived as major barriers to preemptive transplantation.

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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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Increasing Live Donor Kidney Transplantation: A Randomized Controlled Trial of a Home-Based Educational Intervention

Cited by 181 publications

References 30 publications

Home-Based Family Intervention Increases Knowledge, Communication and Living Donation Rates: A Randomized Controlled Trial

Home-Based Family Intervention Increases Knowledge, Communication and Living Donation Rates: A Randomized Controlled Trial

A Survey of Nephrologists’ Views on Preemptive Transplantation

Neighborhood Segregation and Access to Live Donor Kidney Transplantation

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