Transplant social worker and donor financial assistance to increase living donor kidney transplants among African Americans: The TALKS Study, a randomized comparative effectiveness trial

Abstract

Lack of donors hinders living donor kidney transplantation (LDKT) for African Americans. We studied the effectiveness of a transplant social worker intervention (TALK SWI) alone or paired with living donor financial assistance to activate African Americans’ potential living kidney donors. African Americans (N = 300) on the transplant waiting list were randomly assigned to usual care; TALK SWI; or TALK SWI plus Living Donor Financial Assistance. We quantified differences in live kidney donor activation (composite rate of live donor inquiries, completed new live donor evaluations, or live kidney donation) after 12 months. Participants’ mean age was 52 years, 56% were male, and 43% had annual household income less than $40,000. Most previously pursued LDKT. Participants were highly satisfied with TALK social workers, but they rarely utilized Financial Assistance. After 12 months, few (n = 39, 13%) participants had a new donor activation event (35 [12%] new donor inquiries; 17 [6%] new donor evaluations; 4 [1%] LDKT). There were no group differences in donor activation events (subdistribution hazard ratio [95% CI]: 1.09 [0.51–2.30] for TALK SWI and 0.92 [0.42–2.02] for TALK SWI plus Financial Assistance compared to Usual Care, p = 91). Alternative interventions to increase LDKT for African Americans on the waiting list may be needed. Trial registration: ClinicalTrials.gov (NCT02369354).

Examining post-donation outcomes in Hispanic/Latinx living kidney donors in the United States: A systematic review

“…HCHS/SOL is a multicenter epidemiologic study that has enrolled over 16 000 Hispanic adults living in the United States and aims to propagate future research examining health disparities among Hispanic communities 48,49 . In addition to reproaching how data are collected, investigators have redesigned health interventions targeting Hispanic communities, with a focus on cultural competency, which refers to “a set of congruent behaviors, attitudes, and policies that come together in a system, agency, or among professionals that enables effective work in cross‐cultural situations.” 50 Within transplantation, cultural competency has been a critical component of health interventions aimed at mitigating persistent disparities in LDKT rates among minority populations 14,15,51,52 . To date, interventions aimed at increasing LDKT among Hispanic donors include a culturally competent educational website about LDKT, 53,54 a Spanish language mass media campaign on living organ donation attitudes and perceptions among Hispanics, 55 a hospital‐based, culturally sensitive LDKT‐specific educational program, 56 and the development of a culturally competent transplant program 57–59 .…”

Perceptions of Live Donor Kidney Transplantation Using Segmentation Analysis and Perceptual Mapping to Understand Differences by Self-Reported Health Status in People on Dialysis

“…This, along with evidence that potential recipients overestimate the struggles donors face when deciding to donate (Stothers et al, 2005), further demonstrates the need to explore potential recipients' conceptualization of LDKT. It should be noted that researchers have developed interventions to educate potential recipients to change LDKT perceptions (Arriola et al, 2014;Weng et al, 2017;LaPoint et al, 2018;Boulware et al, 2021;Waterman, 2021) and a few are routinely offered by transplant centers outside of a research context (Waterman, 2021). But many of these interventions do not tailor the interventions to the specific needs of patients based on potential differences in LDKT perceptions.…”

Journey to Transplant: Developing a social support network counselling intervention to improve kidney transplantation

“…Additional promising coaching and education interventions have been developed, though they target the individual patient and often require multiple follow‐up visits, potentially complicating implementation 10 . A review on strategies to increase living kidney donation concluded that targeting transplant candidates and their social support networks is a promising point of intervention, 11 such as that employed by the TALKS intervention 12 . However, this social worker‐directed intervention was focused on living donation, and while social workers are often trained in counselling, they may not be able to provide the additional medical counselling that patients and their social support networks need to navigate the Journey to Transplant.…”

“… 10 A review on strategies to increase living kidney donation concluded that targeting transplant candidates and their social support networks is a promising point of intervention, 11 such as that employed by the TALKS intervention. 12 However, this social worker‐directed intervention was focused on living donation, and while social workers are often trained in counselling, they may not be able to provide the additional medical counselling that patients and their social support networks need to navigate the Journey to Transplant. The Kidney COACH program 13 also seeks to activate a member of the social support network to seek living donation, but is targeted to one support member of a waitlisted patient, does not seek to improve overall access to transplant and is more standardized information than individualized to the barriers faced by a specific patient.…”