Barriers to live donor kidney transplants in the pediatric population: A single‐center experience

Abstract

A decrease in live donor pediatric kidney transplants has occurred in the United States. This study investigates barriers that may influence access to live donor kidney transplants in children. Retrospective chart review was conducted for 91 children (69% male, mean age 11.9 years) who underwent pretransplant workup from 2005 to 2015 at an urban pediatric hospital. Fifty-four percent were African American, 32% Caucasian, 8% Arabic, 3% Hispanic, and 3% Others. Government-sponsored insurance (Medicaid/Medicare) was utilized by 73%, and 54% had dual caregivers. Only nine of 68 kidney transplants were live donor transplants. Live donor transplants (11%) were significantly (P=.008) lower than deceased donor transplants (59%) in African Americans. Private insurance was reported by 56% of live donor recipients and 25% of deceased donor recipients. Among live donor recipients, 78% were from dual caregiver families. Caregiver, health-related, financial, and religious/cultural barriers to live donor transplants were reported, several of which may be amenable to positive intervention.

The choice between deceased‐ vs living‐donor renal transplantation in children: Analysis of data from a Belgian tertiary center

“…The financial barrier is especially important in single‐parent families or those with a single breadwinner. Taormina et al reported financial‐ and caregiver‐related issues among the main factors preventing LD KT in a single center in the USA . In our practice, Belgian parents often decline living donation due to the sheer cost of the pretransplantation work‐up as well as the lack of insurance coverage for the post‐operative period for self‐employed parents.…”

“…13,14 Home-based education as an intervention resulted in an increased attitude toward donating a kidney and a higher willingness to donate a kidney. 14 15 In our practice, Belgian parents often decline living donation due to the sheer cost of the pretransplantation work-up as well as the lack of insurance coverage for the post-operative period for self-employed parents. There is clearly need for the legal regulations facilitating living kidney donation for pediatric patients.…”

Low renal transplantation rates in children with end‐stage kidney disease: A study of barriers in a low‐resource setting

“…Given the challenges associated with achieving a deceased‐donor kidney transplant, refusal to consent to organ donation presents a critical barrier to transplantation. In high resource countries, negative attitudes towards organ donation result from a lack of motivation, inadequate knowledge among patients about the donation process and concerns about risks associated with organ donation 29‐31 . Similar barriers likely exist in our setting, although data on patient attitudes in low‐resource countries are minimal.…”

Trends in Living Donation by Race and Ethnicity Among Children With End-stage Renal Disease in the United States, 1995–2015

“…Additionally, cultural barriers to live donor kidney transplants have been described in the adult literature, but parallel data are limited in pediatric populations even though it is likely that these barriers also contribute to the observed racial disparities in living donation to children. 20 , 21 Given that as little as 12–18 months of dialysis confers substantial increased risk for both graft failure and death in children with ESRD, it remains imperative to promote timely transplantation, which may be facilitated by improving living donation. 22 …”