Racial disparities in reaching the renal transplant waitlist: is geography as important as race?

Saunders, Milda R.; Lee, Haena; Alexander, G. Caleb; Tak, Hyo Jung; Thistlethwaite, J. Richard; Ross, Lainie Friedman

doi:10.1111/ctr.12547

Cited by 40 publications

(58 citation statements)

References 43 publications

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“…These imbalances disproportionately affect patients with fewer resources, who cannot relocate to join more favorable waiting lists 59,71 . Matching limitations often fall hardest on populations with small pools of potential matching donors, particularly among children and ethnic minorities 60,61,72,73 .…”

Section: The Unrealized Potential Of Organ Transplantationmentioning

confidence: 99%

“…With distance no longer a factor in donor–recipient matching, closer matches could be achieved. This could decrease rejection and the need for immunosuppression 70 and extend graft life span, while increasing access to transplantation for disadvantaged patient populations 60,73 . Organs could also be routed through specialized facilities, which have been suggested by several groups as a way to make technically challenging assessment, repair, functional augmentation, or banking procedures a clinical reality 7,87,91 .…”

Section: Organ Transplantation Without Preservation Constraintsmentioning

confidence: 99%

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The promise of organ and tissue preservation to transform medicine

et al. 2017

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The ability to replace organs and tissues on demand could save or improve millions of lives each year globally and create public health benefits on par with curing cancer. Unmet needs for organ and tissue preservation place enormous logistical limitations on transplantation, regenerative medicine, drug discovery, and a variety of rapidly advancing areas spanning biomedicine. A growing coalition of researchers, clinicians, advocacy organizations, academic institutions, and other stakeholders has assembled to address the unmet need for preservation advances, outlining remaining challenges and identifying areas of underinvestment and untapped opportunities. Meanwhile, recent discoveries provide proofs of principle for breakthroughs in a family of research areas surrounding biopreservation. These developments indicate that a new paradigm, integrating multiple existing preservation approaches and new technologies that have flourished in the past 10 years, could transform preservation research. Capitalizing on these opportunities will require engagement across many research areas and stakeholder groups. A coordinated effort is needed to expedite preservation advances that can transform several areas of medicine and medical science.

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Section: The Unrealized Potential Of Organ Transplantationmentioning

confidence: 99%

Section: Organ Transplantation Without Preservation Constraintsmentioning

confidence: 99%

The promise of organ and tissue preservation to transform medicine

et al. 2017

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“…There is the potential for delay in early steps of the transplant process (3)(4)(5)(6), where racial and socioeconomic disparities exist in access to each transplant step (7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Transplant Center Patient Navigator and Access to Transplantation among High-Risk Population

Basu¹,

Petgrave-Nelson

Smith

et al. 2018

CJASN

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Background and objectives Barriers exist in access to kidney transplantation, where minority and patients with low socioeconomic status are less likely to complete transplant evaluation. The purpose of this study was to examine the effectiveness of a transplant center-based patient navigator in helping patients at high risk of dropping out of the transplant evaluation process access the kidney transplant waiting list.Design, setting, participants & measurements We conducted a randomized, controlled trial of 401 patients (n=196 intervention and n=205 control) referred for kidney transplant evaluation (January 2013 to August 2014; followed through May 2016) at a single center. A trained navigator assisted intervention participants from referral to waitlisting decision to increase waitlisting (primary outcome) and decrease time from referral to waitlisting (secondary outcome). Time-dependent Cox proportional hazards models were used to determine differences in waitlisting between intervention and control patients.Results At study end, waitlisting was not significantly different among intervention (32%) versus control (26%) patients overall (P=0.17), and time from referral to waitlisting was 126 days longer for intervention patients. However, the effectiveness of the navigator varied from early (,500 days from referral) to late ($500 days) followup. Although no difference in waitlisting was observed among intervention (50%) versus control (50%) patients in the early period (hazard ratio, 1.03; 95% confidence interval, 0.69 to 1.53), intervention patients were 3.3 times more likely to be waitlisted after 500 days (75% versus 25%; hazard ratio, 3.31; 95% confidence interval, 1.20 to 9.12). There were no significant differences in intervention versus control patients who started evaluation (85% versus 79%; P=0.11) or completed evaluation (58% versus 51%; P=0.14); however, intervention patients had more living donor inquiries (18% versus 10%; P=0.03).Conclusions A transplant center-based navigator targeting disadvantaged patients improved waitlisting but not until after 500 days of follow-up. However, the absolute effect was relatively small.

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“…For patients with end‐stage renal disease (ESRD), kidney transplantation is associated with higher quality of life, lower healthcare expenditure, and lower mortality compared to dialysis . Racial disparities in access to kidney transplantation have been well documented, and the underlying causes of these disparities are diverse . Disparities in access to kidney transplant due to patient‐level factors, such as age, education, income, insurance status, and socioeconomic status have all been investigated .…”

Section: Introductionmentioning

confidence: 99%

“…Time from dialysis initiation to transplant waitlist may serve as a better marker for access because it measures nonbiological social factors . Prior work has shown that racial disparities in transplant waitlist exist at the national and regional levels . In addition, it has been observed that geographical variation and neighborhood characteristics play an important role in access to the renal transplant waitlist …”

Section: Introductionmentioning

confidence: 99%