Racial Differences in Outcomes of the Evaluation of Potential Live Kidney Donors: A Retrospective Cohort Study

Weng, Francis L.; Dhillon, Navdeep; Lin, Yong Sheng; Mulgaonkar, Shamkant; Patel, Anup

doi:10.1159/000337949

Cited by 23 publications

(23 citation statements)

References 39 publications

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“…Thus, one potential source of racial disparities in LDKT could be delays during completion of the living donor evaluation process. Previous single‐center studies have reported that AA donor candidates may have a lower likelihood of clinical suitability for donor nephrectomy . Additionally, AA donor candidates may be more likely to be deemed medically ineligible, lost to follow‐up, and decide against donation .…”

Section: Introductionmentioning

confidence: 99%

Racial differences in completion of the living kidney donor evaluation process

Kumar

Tonascia

Muzaale

et al. 2018

Clinical Transplantation

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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: 0.47 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: 0.62 P = .02) and from clearance to donation (aHR: 0.51 P = .02), compared with from referral to medical screening (aHR: 1.02 P = .95) and from in-person evaluation to clearance (aHR: 0.93 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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Section: Introductionmentioning

confidence: 99%

Racial differences in completion of the living kidney donor evaluation process

Kumar

Tonascia

Muzaale

et al. 2018

Clinical Transplantation

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“…Studies have identified multiple potential barriers to living kidney donation, including completing the evaluation process (2), concern about health risks (3–7), geographic distance from the transplant center (8), and donation-related financial concerns (9–12). Donation-related financial concerns have received increased attention given the potential for intervention, with a 2015 consensus statement from the American Society of Transplantation calling for the reduction of financial barriers to living donor kidney transplantation and the achievement of financial neutrality for LKDs (13).…”

Section: Introductionmentioning

confidence: 99%

Factors associated with perceived donation-related financial burden among living kidney donors

Ruck

Holscher

Purnell

et al. 2018

American Journal of Transplantation

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The perception of living kidney donation-related financial burden affects willingness to donate and the experience of donation, yet no existing tools identify donors who are at higher risk of perceived financial burden. We sought to identify characteristics that predicted higher risk of perceived financial burden. We surveyed 51 living kidney donors (LKDs) who donated from 01/2015 to 3/2016 about socioeconomic characteristics, predonation cost concerns, and perceived financial burden. We tested associations between both self-reported and ZIP code-level characteristics and perceived burden using Fisher's exact test and bivariate modified Poisson regression. Donors who perceived donation-related financial burden were less likely to have an income above their ZIP code median (14% vs. 72%, P = .006); however, they were more likely than donors who did not perceive burden to rent their home (57% vs. 16%, P = .03), have an income <$60 000 (86% vs. 20%, P = .002), or have had predonation cost concerns (43% vs. 7%, P = .03). Perceived financial burden was 3.6-fold as likely among those with predonation cost concerns and 10.6-fold as likely for those with incomes <$60 000. Collecting socioeconomic characteristics and asking about donation-related cost concerns prior to donation might allow transplant centers to target financial support interventions toward potential donors at higher risk of perceiving donation-related financial burden.

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“…A possible explanation for the higher proportion of geographically distant donors who were Black is that Black transplant candidates may lack willing and medically suitable donor volunteers who live nearby. Prior studies have documented that potential living kidney donors who are Black are more likely to be medically unsuitable to donate and less likely to complete the evaluation process [14, 16]. Black transplant candidates, who may lack suitable and willing donors who live nearby, may need to rely upon geographically distant family and friends to donate.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, we could not determine if geographically distant potential donors are less likely to donate. Only a minority of potential living kidney donors actually donate, and the reasons for non-donation are numerous [14]. The proportion of potential living kidney donors who “drop out” of the donation process for non-medical reasons varies widely between centers [16, 18-21].…”

Section: Discussionmentioning

confidence: 99%

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Characteristics and Evaluation of Geographically Distant vs Geographically Nearby Living Kidney Donors

Weng

Lee

Dhillon

et al. 2016

Transplantation Proceedings

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Background Living donor kidney transplant (LDKT) can be impeded by multiple barriers. One possible barrier to LDKT is a large physical distance between the living donor's home residence and the procuring transplant center. Methods We performed a retrospective, single-center study of U.S. living kidney donors who were geographically distant (residing ≥150 miles) from our transplant center. Each distant donor was matched to four geographically nearby donors (<150 miles from our center) as controls. Results From 2007-2010, of 429 live kidney donors, 55 (12.8%) were geographically distant. Blacks comprised a higher proportion of geographically distant vs. nearby donors (34.6% vs. 15.5%), while Hispanics and Asians comprised a lower proportion (P=0.001). Distant vs. nearby donors had similar median times from donor referral to actual donation (165 vs. 161 days, P=0.81). The geographically distant donors lived a median of 703 miles (25%-75% range 244-1072) from our center and 21.2 miles (25%-75% range, 9.8-49.7) from the nearest kidney transplant center. The proportion of geographically distant donors who had their physician evaluation (21.6%), psychosocial evaluation (21.6%), or CT angiogram (29.4%) performed close to home, rather than at our center, was low. Conclusions Many geographically distant donors live close to transplant centers other than the procuring transplant center, but few of these donors perform parts of their donor evaluation at these closer centers. Blacks comprise a large proportion of geographically distant donors. The evaluation of geographically distant donors, especially among minorities, warrants further study.

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Racial Differences in Outcomes of the Evaluation of Potential Live Kidney Donors: A Retrospective Cohort Study

Cited by 23 publications

References 39 publications

Racial differences in completion of the living kidney donor evaluation process

Racial differences in completion of the living kidney donor evaluation process

Factors associated with perceived donation-related financial burden among living kidney donors

Characteristics and Evaluation of Geographically Distant vs Geographically Nearby Living Kidney Donors

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