Destination Transplant: Protocol for a Parallel-group Randomized Trial of an Educational Intervention to Increase Kidney Transplant Among Black People on the Transplant Waiting List

Abstract

Background. For most patients with kidney failure, living donor kidney transplant (LDKT) is their best treatment option. Compared with White people, Black people are more likely to have kidney failure but less likely to receive LDKTs. In this study, the investigators will test an educational intervention, Destination Transplant, designed to reduce this disparity, among Black people already listed for kidney transplant. Methods. The investigators will conduct a parallel group, 2-arm randomized clinical trial among 500 Black kidney transplant candidates. The main objective of this study is to test an educational and behavioral intervention that is designed to increase receipt of LDKT among transplant candidates (persons active on the deceased donor kidney transplant waiting list) who are Black. Candidates on the kidney transplant waiting list will be randomly assigned to 1 of 2 conditions: (1) a control group that will receive Usual Care, or (2) an Intervention group that will receive Destination Transplant, a 9-month intervention that includes an in-person group-based education session, postcards at monthly intervals, and a follow-up phone call from a transplant educator. At baseline and during 18 months of follow-up, demographic and clinical variables will be collected, as well as variables such as transplant derailers (factors that might be sources of delay, difficulty, or challenge to pursuing transplant), transplant knowledge, and health literacy, small steps taken to pursue LDKT, readiness for LDKT, decisional balance and self-efficacy LDKT, decisional conflict, family support, availability of potential living donors, and general health status. Conclusions. This educational intervention aims to increase both readiness to pursue LDKT and actual receipt of LDKTs among Black and African American patients who are already on the kidney transplant waiting list. The aim of the intervention is to reduce racial disparities in access to LDKT.

A scoping review of inequities in access to organ transplant in the United States

“…A parallel group, two-arm randomized controlled trial is testing an educational and behavioral intervention designed to increase receipt of LDKT among Black transplant candidates [ 126 ]. Candidates on the waitlist are randomly assigned to one of two conditions: (1) a control group that will receive usual care, or (2) an intervention group that will receive Destination Transplant, a nine-month intervention that includes an in-person group-based education session, postcards at monthly intervals, and a follow-up phone call from a transplant educator.…”

Nonmedical barriers to early steps in kidney transplantation among underrepresented groups in the United States

“…Last, health-system level interventions could lead to sustainable reductions in racial disparities in transplant access. Accumulating evidence has shown that multicomponent education and quality improvement interventions at the transplant program and dialysis facility-level can improve transplant access and reduce disparities in referral [38,39], waitlisting, and living donor transplant [40,41]. Despite this, interventions have not been implemented nationally, and it is unclear how sustainable these interventions are in practice, though some short-term studies (12 months) demonstrate sustainability and feasibility for dissemination across ESKD networks [38].…”

Knowledge About Renal Transplantation Among African, Caribbean, and Black Canadian Patients With Advanced Kidney Failure

“…Previous studies have documented mistrust in the healthcare system among racialized patients 32 , 33 , 71 , 72 and transplant system. 34 , 35 , 36 , 70 ACB patients have indicated an interest in LDKT if educational interventions are done in groups with other ACB patients, 73 and if education is provided by someone who shared their background. Therefore, there is a need for culturally responsive educational interventions that address both LDKT knowledge and work to develop trust among ACB communities.…”