Awareness of Racial Disparities in Kidney Transplantation among Health Care Providers in Dialysis Facilities

Kim, Joyce J.; Basu, Mohua; Plantinga, Laura C.; Pastan, Stephen O.; Mohan, Sumit; Smith, Kayla; Melanson, Taylor; Escoffery, Cam; Patzer, Rachel E.

doi:10.2215/cjn.09920917

Cited by 36 publications

(38 citation statements)

References 35 publications

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“…This is especially true given that we found that patients most often turned to their physicians for information when choosing centers, but prior studies have shown that healthcare providers have limited awareness of the allocation system or of disparities in kidney transplantation. 24,25 Disparities in patient education about transplant have direct effects on access to transplantation, and prior studies have found that patient education has the ability to reduce racial and socioeconomic disparities in completion of transplant evaluation. 11,26 Furthermore, prior studies have found that patients with lower education attainment were more likely to report psychosocial concerns regarding pursuing transplantation, and less likely to believe transplantation would be advantageous.…”

Section: Discussionmentioning

confidence: 99%

Patients prioritize waitlist over posttransplant outcomes when evaluating kidney transplant centers

Husain

Brennan

Michelson

et al. 2018

American Journal of Transplantation

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Factors that patients value when choosing a transplant center have not been well studied. In order to guide the improvement of patient-facing materials, we conducted an anonymous electronic survey of patients that assessed the relative importance of patient experience, practical considerations, transplant center reputation, center experience, and waitlist when selecting a transplant center. A total of 409 respondents completed the survey, of whom 68% were kidney transplant recipients and 32% had chronic kidney disease or were on dialysis. Participants had mean age 56 ± 12 years and were predominantly female (61%), white (79%), and had an associate's degree or higher (68%). Participants most often prioritized waitlist when evaluating transplant centers (transplanted 26%, chronic kidney disease 40%), and waitlist was almost twice as likely as outcomes to be ranked most important (30% vs 17%). Education level and transplant status were significantly associated with factors used for center prioritization. Waitlisted respondents most commonly (48%) relied on physicians for information when selecting a center, while a minority cited transplant-specific organizations. In order to improve shared decision-making, materials outlining center-specific waitlist features should be prioritized. Novel patient-oriented metrics for measuring transplant center quality that align with patient priorities must be explored.

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Section: Discussionmentioning

confidence: 99%

Patients prioritize waitlist over posttransplant outcomes when evaluating kidney transplant centers

Husain

Brennan

Michelson

et al. 2018

American Journal of Transplantation

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“…Furthermore, vulnerable patients or those with lower education or health literacy levels may have limited awareness of the survival benefit of transplantation compared to other modalities . Coupled with evidence of limited provider awareness of several aspects of the transplant system, including evidence of disparities in access, research suggests that incorporating patient preferences as early as possible into the process could promote shared decision‐making.…”

Section: Discussionmentioning

confidence: 99%

Current opinions in organ allocation

Achille¹,

Agarwal²,

Albert³

et al. 2018

American Journal of Transplantation

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Existing methods of academic publication provide limited opportunity to obtain stakeholder input on issues of broad interest. This article reports the results of an experiment to produce a collaborative, crowdsourced article examining a current controversial issue in transplant medicine (hereby referred to as the "C4 Article"). The editorial team as a whole selected the topic of organ allocation, then divided into six sections, each supported by an individual editorial team. Widely promoted by the American Journal of Transplantation, the C4 Article was open for public comment for 1 month. The nonblinded editorial teams reviewed the contributions daily and interacted with contributors in near-real time to clarify and expand on the content received. Draft summaries of each section were posted and subsequently revised as new contributions were received. One hundred ninety-four individuals viewed the manuscript, and 107 individuals contributed to the manuscript during the submission period. The article engaged the international transplant community in producing a contemporary delineation of issues of agreement and controversy related to organ allocation and identified opportunities for new policy development. This initial experience successfully demonstrated the potential of a crowdsourced academic manuscript to advance a broad-based understanding of a complex issue. K E Y W O R D S disparities, donors and donation, editorial/personal viewpoint, organ transplantation in general, waitlist management 1 | INTRODUC TI ON This manuscript is the result of an experiment to produce a collaborative, crowdsourced article examining a current and controversial issue in the field of transplantation. This C4 Article examines the issue of organ allocation. The perennial shortage of organs impacts all aspects of transplantation from basic research to health policy. Unlike other areas of medicine in which the need for care exceeds available resources, the scarcity of organs for transplantation cannot be rectified by a simple injection of funds. The rationing of available lifesaving organs is a reality of contemporary transplant medicine achieved through organ allocation rules. Principles of both utility and justice inform these rules. In the context of organ allocation, these principles are frequently in conflict. Periodic review of organ allocation policies ensures the optimal balance of the principles of justice and utility, and ensures policies are consistent with the values of all stakeholders. This C4 Article provides a unique opportunity to acquire broad stakeholder input on several key issues related to organ allocation policy. Contributors examined six issues selected by the editors, including who should determine organ allocation policy, which policies should be adopted to increase organ utilization, what is the minimal acceptable outcome for an organ transplant, what role should patient choice play in organ allocation policy, should nonmedical factors be used in organ allocation policy, and which policies should be advanced...

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“…There is a large body of literature trying to explain these differences. No definite explanations have been described, and the majority of researchers agree that it is the result of a combination of environmental (eg, a western diet, sedentary life style, and increased consumption of salt), genetic (predisposition to salt retention and APOL 1 genotype), and possibly social (access to care for early diagnosis of hypertension and affordability of treatment) factors …”

Section: Introductionmentioning

confidence: 99%

“…It increases patients’ life expectancy, improves quality of life, and is more cost‐effective than dialysis. Certain studies have reported differences in access to kidney transplantation between African Americans and Whites . Although African Americans comprise close to 37% of the kidney waiting list, they receive 25% of deceased and 14% of living donor transplants .…”

Section: Introductionmentioning

confidence: 99%

Different outcomes after kidney transplantation between African Americans and Whites: A matter of income? A single‐center study

Arvelakis

Lerner

Wadhera

et al. 2019

Clinical Transplantation

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End-stage renal disease is more frequent in African Americans than Whites. Although African Americans comprise 13% of the US population, 1 they represent 37% of the patients with end-stage renal disease and 33% of the patients on the waiting list for a kidney transplant. 2 New cases of ESRD are 4 times more common among African Americans than Whites. 3 The leading cause of ESRD in AA patients is hypertension. Hypertension is more common in AA than Whites, and it also is more prevalent in the United States than any other black subpopulation around the world, especially in the sub-Saharan area where it is fairly uncommon. 4,5 Apart from hypertension, any potential nephrotoxic condition puts AA patients at higher risk for ESRD than Whites. 6,7 Recent data have shown that AA living kidney donors also have a higher chance of needing transplantation than Whites. 8 There is a large body of literature trying to explain these differences. No definite explanations have been described, and the majority of researchers agree that it is the result of a combination of Abstract Background: Our center has one of the largest representations of African Americans in listed and transplanted patients. We investigated if and how racial differences affect outcomes in our patient population. Methods: We performed a retrospective analysis of all kidney transplants inAfrican American and (non-Hispanic) White patients in our center from 1/1/2005 to 12/31/2014. Cox regression was performed to evaluate the adjusted hazard ratios for graft loss. We investigated the influence of socioeconomic status on transplant outcomes. We stratified our patients into three groups based on income: lower (<$50 000 annual household income), medium ($50 000-100 000 annual household income), and higher (>$100 000 annual household income.Results: There were 1333 patients in our study, 696 Whites and 637 African Americans. The 1-, 5-, and 10-year graft survival between the two groups was 96.5% vs 91.1%, 89% vs 80.7%, and 77% vs 66.3%, respectively (P < .001 by Log Rank, Breslow and Taron-Ware). When we compared the two groups separately in each income category, we found no statistical difference between African Americans and Whites in graft survival. In the regression model, income and not race was the significant factor influencing graft survival (P < .001 vs P = .61).

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Awareness of Racial Disparities in Kidney Transplantation among Health Care Providers in Dialysis Facilities

Abstract: Among a limited sample of dialysis facilities with low waitlisting, provider awareness of racial disparities in kidney transplant waitlisting was low, particularly among staff who may have more routine contact with patients.

Cited by 36 publications

References 35 publications

Patients prioritize waitlist over posttransplant outcomes when evaluating kidney transplant centers

Patients prioritize waitlist over posttransplant outcomes when evaluating kidney transplant centers

Current opinions in organ allocation

Different outcomes after kidney transplantation between African Americans and Whites: A matter of income? A single‐center study

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