Racial and Socioeconomic Disparities in the Allocation of Expanded Criteria Donor Kidneys

Mohandas, Rajesh; Casey, Michael J.; Cook, Robert L.; Lamb, Kenneth; Wen, Xuerong; Segal, Mark S.

doi:10.2215/cjn.01430213

Cited by 20 publications

(9 citation statements)

References 24 publications

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“…Although several studies show significant impact of socioeconomic variables on WTD , there is lack of consensus on the sign of influence. Evidence from Switzerland shows education as a significant predictor of organ donation, but others show no such link . Another study on Canada found a positive link between income and WTD .…”

Section: Literature Reviewmentioning

confidence: 99%

Deceased Donor Organs: What Can Be Done to Raise Donation Rates Using Evidence From Malaysia?

Rasiah

Manikam

Chandrasekaran

et al. 2016

American Journal of Transplantation

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Organ donation rates have continued to fall seriously short of needs worldwide, with the lowest rates recorded among developing economies. This study seeks to analyze evidence from a developing economy to explore the usefulness of social psychological theory to solve the problem. The study deployed a large survey (n = 10 412) using a convenience sampling procedure targeted at increasing the number of Malaysians registered with the Ministry of Health, Malaysia who are willing to donate organs upon death. Structural equation modeling was deployed to estimate simultaneously the relative influence of cognitive and noncognitive variables on willingness to donate deceased organs. The cognitive factors of donation perception, socioeconomic status and financial incentives, and the noncognitive factors of demography and fear showed a high statistically significant (1%) relationship with willingness to donate organs after death. While financial incentives were significant, cash rewards showed the least impact. Donation perception showed the highest impact, which shows that the development of effective pedagogic programs with simultaneous improvements to the quality of services provided by medical personnel engaged in retrieving and transplanting deceased donor organs can help raise organ donation rates.

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Section: Literature Reviewmentioning

confidence: 99%

Deceased Donor Organs: What Can Be Done to Raise Donation Rates Using Evidence From Malaysia?

Rasiah

Manikam

Chandrasekaran

et al. 2016

American Journal of Transplantation

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“…We were able to identify only one study that demonstrated a very strong association between poor health literacy and lack of patients’ enrollment on kidney transplant lists [ 40 ]. It is possible that health literacy may explain part of the currently described disparity in surgical services [ 53 , 54 ]. Future studies attempting to explain disparities in surgical care should incorporate measurements of health literacy in their evaluation.…”

Section: Discussionmentioning

confidence: 99%

The impact of health literacy in the care of surgical patients: a qualitative systematic review

et al. 2015

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BackgroundInadequate health literacy affects more than 90 million Americans and it has been associated with adverse outcomes in the medicine field including increased hospitalization rates and greater mortality. Since surgical patients are often required to make complex decisions and adhere to complex instructions, health literacy may have a profound impact in the surgical practice. The main objective of the current study was to systematically evaluate the role of health literacy in surgical patients.MethodsA systematic search was performed to identify studies that evaluated the role of health literacy in the perioperative setting following the PRISMA guidelines. Only studies that examined health literacy using a validated instrument in the perioperative setting were included.ResultsTen studies including data on 1147 patients were included. The median (IQR) number of patients in the included studies was 101 (30 to 152). The majority of studies used the Short Test of Functional Literacy in adults (STOFHLA) to evaluate patients’ health literacy. Five studies evaluated the patients preoperatively, four studies evaluated patients in the postoperative period and in one study the time of evaluation in relation to the surgical procedure was not defined. The lowest prevalence of inadequate health literacy was detected in kidney transplant patients, 6 out of 124 (5 %), while the highest prevalence of inadequate health literacy was detected in orthopedic patients having total joint replacement, 86 out of 126 (60 %). Inadequate health literacy in the preoperative period was associated with poor medical information comprehension and it may adversely affect adherence to preoperative medications and even modulate surgical disparities. Inadequate health literacy in the postoperative period was associated with poor comprehension of discharge instructions and worse kidney function in transplant recipients.ConclusionsHealth literacy seems to have a very significant impact in the care of surgical patients. More studies to establish the impact of poor health literacy on perioperative outcomes are needed.

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“…HLA is one potential driver of racial/ethnic disparities in transplant 33 , leading to gaps in the rate of transplants between whites and racial/ethnic minorities, despite greater willingness by minorities to accept poorer quality (i.e. expanded criteria donor) organs 34 .…”

Section: Discussionmentioning

confidence: 99%

Racial/Ethnic Differences in the Association Between Hospitalization and Kidney Transplantation Among Waitlisted End-Stage Renal Disease Patients

et al. 2016

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Introduction Even after placement on the deceased donor waitlist, there are racial disparities in access to kidney transplant. The association between hospitalization, a proxy for health while waitlisted, and disparities in kidney transplant has not been investigated. Methods We used United States Renal Data System Medicare-linked data on waitlisted End-Stage Renal Disease (ESRD) patients between 2005 and 2009 with continuous enrollment in Medicare Parts A & B (n=24 581) to examine the association between annual hospitalization rate and odds of receiving a deceased donor kidney transplant. We used multi-level mixed effects models to estimate adjusted odds ratios (aOR), controlling for individual-, transplant center-, and organ procurement organization-level clustering. Results Blacks and Hispanics were more likely than whites to be hospitalized for circulatory system or endocrine, nutritional, and metabolic diseases (p<0.001). After adjustment, compared to individuals not hospitalized, patients who were hospitalized frequently while waitlisted were less likely to be transplanted (>2 vs. 0 hospitalizations/year aOR=0.57, p<0.001). Though blacks and Hispanics were more likely to be hospitalized than whites (p<0.001), adjusting for hospitalization did not change estimated racial/ethnic disparities in kidney transplantation. Conclusions Individuals hospitalized while waitlisted were less likely to receive a transplant. However, hospitalization does not account for the racial disparity in kidney transplantation after waitlisting.

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Racial and Socioeconomic Disparities in the Allocation of Expanded Criteria Donor Kidneys

Cited by 20 publications

References 24 publications

Deceased Donor Organs: What Can Be Done to Raise Donation Rates Using Evidence From Malaysia?

Deceased Donor Organs: What Can Be Done to Raise Donation Rates Using Evidence From Malaysia?

The impact of health literacy in the care of surgical patients: a qualitative systematic review

Racial/Ethnic Differences in the Association Between Hospitalization and Kidney Transplantation Among Waitlisted End-Stage Renal Disease Patients

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