The Effect of Race and Income on Living Kidney Donation in the United States

Gill, Jagbir; Dong, Jianghu; Rose, Caren; Johnston, Olwyn; Landsberg, David; Gill, John S.

doi:10.1681/asn.2013010049

Cited by 93 publications

(75 citation statements)

References 32 publications

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“…Since 2006, national living kidney donation rates have declined, a decrease some have ascribed in part to the downturn in the economic climate in the United States (1,12). Relatively compelling evidence indicates that socioeconomic status is an important factor in access to kidney transplantation (5,14,15). Because transplant candidates are likely to seek donors from similar socioeconomic backgrounds, the lower rate of LDKT among patients with lower socioeconomic status may in part be due to the perceived or actual financial effect that donation may have on potential donors.…”

Section: Background On Systemic Barriers To Living Kidney Donationmentioning

confidence: 99%

Living-Donor Kidney Transplantation

Tushla

Rudow

Milton

et al. 2015

Clinical Journal of the American Society of Nephrology

108

113

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Live-donor kidney transplantation (LDKT) is the best treatment for eligible people with late-stage kidney disease. Despite this, living kidney donation rates have declined in the United States in recent years. A potential source of this decline is the financial impact on potential and actual living kidney donors (LKDs). Recent evidence indicates that the economic climate may be associated with the decline in LDKT and that there are nontrivial financial ramifications for some LKDs. In June 2014, the American Society of Transplantation's Live Donor Community of Practice convened a Consensus Conference on Best Practices in Live Kidney Donation. The conference included transplant professionals, patients, and other key stakeholders (with the financial support of 10 other organizations) and sought to identify best practices, knowledge gaps, and opportunities pertaining to living kidney donation. This workgroup was tasked with exploring systemic and financial barriers to living kidney donation. The workgroup reviewed literature that assessed the financial effect of living kidney donation, analyzed employment and insurance factors, discussed international models for addressing direct and indirect costs faced by LKDs, and summarized current available resources. The workgroup developed the following series of recommendations to reduce financial and systemic barriers and achieve financial neutrality for LKDs: (1) allocate resources for standardized reimbursement of LKDs' lost wages and incidental costs; (2) pass legislation to offer employment and insurability protections to LKDs; (3) create an LKD financial toolkit to provide standardized, vetted education to donors and providers about options to maximize donor coverage and minimize financial effect within the current climate; and (4) promote further research to identify systemic barriers to living donation and LDKT to ensure the creation of mitigation strategies.

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Section: Background On Systemic Barriers To Living Kidney Donationmentioning

confidence: 99%

Living-Donor Kidney Transplantation

Tushla

Rudow

Milton

et al. 2015

Clinical Journal of the American Society of Nephrology

108

113

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“…Precisely how many potential donors choose not to donate because of anticipated financial hardship is currently unknown and warrants investigation, but it is not unreasonable to suggest that these concerns may have contributed to the recent LKD decline during the economic recession in the United States. Indeed, Gill et al (47,48) found that LKD increased the most among those in higher-income groups from 1999 to 2004; however, since 2004, LKD has declined the most in low-income groups, thus accelerating the income difference in LKD rates. In addition, the LKD decline has been most dramatic in low-income blacks relative to all other racial/ethnic and income groups (47).…”

Section: Incomementioning

confidence: 99%

“…Indeed, Gill et al (47,48) found that LKD increased the most among those in higher-income groups from 1999 to 2004; however, since 2004, LKD has declined the most in low-income groups, thus accelerating the income difference in LKD rates. In addition, the LKD decline has been most dramatic in low-income blacks relative to all other racial/ethnic and income groups (47).…”

Section: Incomementioning

confidence: 99%

“…Race and income, for instance, are known to intersect, with low-income blacks experiencing the largest decline in LKD, whereas LKD rates are highest among high-income blacks (47). Strategies that may prove efficacious in attenuating disparity in one area may have little effectiveness or, even worse, may exacerbate differences in another area.…”

Section: Strategies To Reduce Ldkt Disparities: Workgroup Recommendatmentioning

confidence: 99%

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Living Donor Kidney Transplantation

Rodrigue

Kazley

Mandelbrot

et al. 2015

Clinical Journal of the American Society of Nephrology

109

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Despite its superior outcomes relative to chronic dialysis and deceased donor kidney transplantation, live donor kidney transplantation (LDKT) is less likely to occur in minorities, older adults, and poor patients than in those who are white, younger, and have higher household income. In addition, there is considerable geographic variability in LDKT rates. Concomitantly, in recent years, the rate of living kidney donation (LKD) has stopped increasing and is declining, after decades of consistent growth. Particularly noteworthy is the decline in LKD among black, younger, male, and lower-income adults. The Live Donor Community of Practice within the American Society of Transplantation, with financial support from 10 other organizations, held a Consensus Conference on Best Practices in Live Kidney Donation in June 2014. The purpose of this meeting was to identify LKD best practices and knowledge gaps that might influence LDKT, with a focus on patient and donor education, evaluation efficiencies, disparities, and systemic barriers to LKD. In this article, we discuss trends in LDKT/LKD and emerging novel strategies for attenuating disparities, and we offer specific recommendations for future clinical practice, education, research, and policy from the Consensus Conference Workgroup focused on disparities.

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“…1,10 Patients undergoing home dialysis are healthier, have better social support and socioeconomic status, and assume greater responsibility for their own care. 3,11,12 It is, thus, reasonable to postulate that racial/ethnic disparities in transplantation rates may not exist among individuals undergoing PD or home HD.…”

mentioning

confidence: 99%

Racial and Ethnic Disparities in Use of and Outcomes with Home Dialysis in the United States

Mehrotra

Soohoo

Rivara

et al. 2015

JASN

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Home dialysis, which comprises peritoneal dialysis (PD) or home hemodialysis (home HD), offers patients with ESRD greater flexibility and independence. Although ESRD disproportionately affects racial/ethnic minorities, data on disparities in use and outcomes with home dialysis are sparse. We analyzed data of patients who initiated maintenance dialysis between 2007 and 2011 and were admitted to any of 2217 dialysis facilities in 43 states operated by a single large dialysis organization, with follow-up through December 31, 2011 (n=162,050, of which 17,791 underwent PD and 2536 underwent home HD for $91 days). Every racial/ethnic minority group was significantly less likely to be treated with home dialysis than whites. Among individuals treated with in-center HD or PD, racial/ethnic minorities had a lower risk for death than whites; among individuals undergoing home HD, only blacks had a significantly lower death risk than whites. Blacks undergoing PD or home HD had a higher risk for transfer to in-center HD than their white counterparts, whereas Asians or others undergoing PD had a lower risk than whites undergoing PD. Blacks irrespective of dialysis modality, Hispanics undergoing PD or in-center HD, and Asians and other racial groups undergoing in-center HD were significantly less likely than white counterparts to receive a kidney transplant. In conclusion, there are racial/ethnic disparities in use of and outcomes with home dialysis in the United States. Disparities in kidney transplantation evident for blacks and Hispanics undergoing home dialysis are similar to those with in-center HD. Future studies should identify modifiable causes for these disparities.

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The Effect of Race and Income on Living Kidney Donation in the United States

Cited by 93 publications

References 32 publications

Living-Donor Kidney Transplantation

Living-Donor Kidney Transplantation

Living Donor Kidney Transplantation

Racial and Ethnic Disparities in Use of and Outcomes with Home Dialysis in the United States

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