Racial Differences in the Living Kidney Donation Experience and Implications for Education

Lunsford, Shayna L.; Shilling, Lilless M.; Chavin, Kenneth D.; Martin, Margaret S.; Miles, Lucia G.; Norman, Michele L.; Baliga, Prabhakar K.

doi:10.1177/152692480701700312

Cited by 46 publications

(49 citation statements)

References 16 publications

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“…For example, area-level studies that examine the distribution and quality of care within CKD clinics, particularly those that serve racial-ethnic minority communities, may provide valuable insight on how (and whether) expansion of health insurance coverage might change access to high-quality predialysis care for racial-ethnic minority groups. Similarly, studies that incorporate social workers and financial counselors into LDKT educational efforts have reported early success in reducing patients’ financial concerns regarding the LDKT process (40). However, the impact of such interventions on subsequent progress through the LDKT process has yet to be established.…”

Section: Discussionmentioning

confidence: 99%

Racial Differences in Determinants of Live Donor Kidney Transplantation in the United States

Purnell

Leca

et al. 2013

American Journal of Transplantation

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Few studies have compared determinants of live donor kidney transplantation (LDKT) across all major US racial-ethnic groups. We compared determinants of racial-ethnic differences in LDKT among 208 736 patients who initiated treatment for end-stage kidney disease during 2005–2008. We performed proportional hazards and bootstrap analyses to estimate differences in LDKT attributable to sociodemographic and clinical factors. Mean LDKT rates were lowest among blacks (1.19 per 100 person-years [95% CI: 1.12–1.26]), American Indians/Alaska Natives-AI/ANs (1.40 [1.06–1.84]) and Pacific Islanders (1.10 [0.78–1.84]), intermediate among Hispanics (2.53 [2.39–2.67]) and Asians (3.89 [3.51–4.32]), and highest among whites (6.46 [6.31– 6.61]). Compared with whites, the largest proportion of the disparity among blacks (20%) and AI/ANs (29%) was attributed to measures of predialysis care, while the largest proportion among Hispanics (14%) was attributed to health insurance coverage. Contextual poverty accounted for 16%, 4%, 18%, and 6% of the disparity among blacks, Hispanics, AI/ANs and Pacific Islanders but none of the disparity among Asians. In the United States, significant disparities in rates of LDKT persist, but determinants of these disparities vary by race-ethnicity. Efforts to expand preESKD insurance coverage, to improve access to high-quality predialysis care and to overcome socioeconomic barriers are important targets for addressing disparities in LDKT.

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Section: Discussionmentioning

confidence: 99%

Racial Differences in Determinants of Live Donor Kidney Transplantation in the United States

Purnell

Leca

et al. 2013

American Journal of Transplantation

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“…They hypothesized that lack of education may hinder both patients and donors from pursuing live donation. Lunsford et al suggested that education was the best way to attract live donation and dispel myths associated with living donation (19). While a handful of educational programs have been reported, ranging from short instructional videos to an educational question and answer session with transplant staff, many patients still felt ill equipped to pursue live donation and ask others to consider donating (1, 20–22), and interventions of education alone have not been shown to be particularly effective at increasing live donor transplantation rates for participants.…”

Section: Discussionmentioning

confidence: 99%

Live Donor Champion

et al. 2012

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Background Lack of education and reluctance to initiate a conversation about live donor kidney transplantation (LDKT) is a common barrier to finding a donor. While transplant candidates are often hesitant to discuss their illness, friends or family members are often eager to spread awareness, and are empowered by advocating for the candidates. We hypothesized that separating the advocate from the patient is important in identifying live donors. Methods We developed an intervention to train a Live Donor Champion (LDC) (a friend, family member, or community member willing to advocate for the candidate) for this advocacy role. We compared outcomes of 15 adult KT candidates who had no prospective donors and underwent the LDC intervention with 15 matched controls from our waiting list. Results Comfort in initiating a conversation about transplantation increased over time for LDCs. Twenty-five potential donors contacted our center on behalf of LDC participants; four participants achieved LDKT and three additional participants have donors in evaluation, compared to zero among matched controls (p<0.001). Conclusions Transplant candidates are ill-equipped to seek live donors; by separating the advocate from the patient, understandable concerns about initiating conversations are reduced.

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“…Potential live donors, especially those who are Black, harbor concerns about their future health if they donate [12–14]. Potential donors who are Black also reported concerns about the financial costs of donation [13, 15]. Other possible barriers, such as cultural beliefs or interpersonal interactions, have rarely been examined among Black donors.…”

Section: Introductionmentioning

confidence: 99%

Inter- and Intrapersonal Barriers to Living Donor Kidney Transplant among Black Recipients and Donors

Davis

Grogan

Cox

et al. 2016

J. Racial and Ethnic Health Disparities

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Context End-stage renal disease (ESRD) is more common among Blacks, but Blacks are less likely to receive a live donor kidney transplant (LDKT). Objective The objective of this study is to identify barriers and coping mechanisms that Black LDKT recipients and donors experienced while receiving or donating a kidney. Design A qualitative study was conducted using structured interviews. Thematic analysis was used for data interpretation. Participants All 20 participants identified as Black, with two participants identifying themselves as multiracial. The mean age for the 14 recipients was 60, and the average age for the 6 living donors was 47. Results Themes emerging from the data suggest both recipients and donors faced barriers in the LDKT experience. Recipients faced barriers associated with their denial and avoidance of the severity of their ESRD, their desire to maintain the privacy of their health status, and their refusal to approach potential donors. Donors encountered negative responses from others about the donors’ desire to donate and the initial refusal of recipients to accept a LDKT offer. Recipients identified faith as a coping mechanism, while donors identified normalization of donation as their method of coping. Various types of social support helped donors and recipients navigate the transplant process. Conclusion Black LDKT recipients and donors must overcome barriers prior to receiving or donating a kidney. Most of these barriers arise from communication and interactions with others that are either lacking or undesirable. Future interventions to promote LDKT among Blacks may benefit by specifically targeting these barriers.

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Racial Differences in the Living Kidney Donation Experience and Implications for Education

Cited by 46 publications

References 16 publications

Racial Differences in Determinants of Live Donor Kidney Transplantation in the United States

Racial Differences in Determinants of Live Donor Kidney Transplantation in the United States

Live Donor Champion

Inter- and Intrapersonal Barriers to Living Donor Kidney Transplant among Black Recipients and Donors

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