Impact of Navigators on First Visit to a Transplant Center, Waitlisting, and Kidney Transplantation

Sullivan, Catherine; Barnswell, K.V.; Greenway, Kate; Kamps, C.M.; Wilson, D. M.; Albert, Jeffrey M.; Dolata, Jacqueline; Huml, Anne M.; Pencak, Julie; Ducker, John T.; Gedaly, Roberto; Jones, Christopher M.; Pesavento, Todd E.; Sehgal, Ashwini R.

doi:10.2215/cjn.03100318

Cited by 13 publications

(11 citation statements)

References 22 publications

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“…Numerous interventions have attempted to attenuate disparities in transplantation access including peer navigation mobile decision aids, telemedicine, and targeted education among dialysis facility staff with varying effectiveness 11‐13 . Despite these interventions national rates of placement on the waiting list among patients with lower historic rates of transplantation have not increased.…”

Section: Viewpointmentioning

confidence: 99%

An opt-out model for kidney transplant referral: The time has come

Huml

Sedor

Poggio

et al. 2021

American Journal of Transplantation

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Kidney transplantation is cost effective, improves patients' quality of life, and provides a survival benefit relative to maintenance dialysis. 1-3 The benefits of transplantation extend to patients with comorbid conditions and among patients receiving relatively high-risk donor organs. 4,5 Highly prevalent racial ethnic gender geographic and socioeconomic disparities affect equitable access in kidney transplant. In addition evidence from the United States and Canada has documented substantial variability in referral rates for kidney transplantation among dialysis facilities (from 0%-100%) and higher rates of wait listing among those facilities with higher referral suggesting there are many end-stage kidney disease (ESKD) patients who may be eligible for kidney transplantation but have not yet been referred. 6,7 Improving access to the kidney transplant waiting list remains a prominent challenge for the nephrology and transplant communities. 8-10 Numerous interventions have attempted to attenuate disparities in transplantation access including peer navigation mobile decision aids, telemedicine, and targeted education among dialysis facility staff with varying effectiveness. 11-13 Despite these interventions national rates of placement on the waiting list among patients with lower historic rates of transplantation have not increased. Targeted policy interventions contained in the 2014 changes to the kidney allocation system have improved transplant access among racial minorities who are placed on the kidney transplant waiting list. 14-16 In addition Medicaid expansion enabled by implementation of the Affordable Care Act has increased preemptive waitlisting for kidney transplant even among minorities. But it is unclear whether these changes are sustainable. 17-19

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Section: Viewpointmentioning

confidence: 99%

An opt-out model for kidney transplant referral: The time has come

Huml

Sedor

Poggio

et al. 2021

American Journal of Transplantation

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“…Utilization of a previous kidney transplant recipient as a navigator in dialysis centers resulted in completion of more early steps of transplant referral. 26 Other randomized studies using previous kidney transplant recipients as navigators 27 or transplant social workers as navigators, 28 however, did not result in increased evaluations or waitlistings. Implementation of an intensive half-day structured education, held in concert with a formal transplant evaluation, resulted in a 38% higher probability of completing the evaluation process within 1 year compared to historic controls.…”

Section: Discussionmentioning

confidence: 99%

A Dialysis Center Educational Video Intervention Increases Patient Self-Efficacy and Kidney Transplant Evaluations

Morinelli

Taber

et al. 2021

Prog Transpl

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Introduction: The optimal treatment for end-stage kidney disease is renal transplant. However, only 1 in 5 (21.5%) patients nationwide receiving dialysis are on a transplant waitlist. Factors associated with patients not initiating a transplant evaluation are complex and include patient specific factors such as transplant knowledge and self-efficacy. Research Question: Can a dialysis center-based educational video intervention increase dialysis patients’ transplant knowledge, self-efficacy, and transplant evaluations initiated? Design: Dialysis patients who had not yet completed a transplant evaluation were provided a transplant educational video while receiving hemodialysis. Patients’ transplant knowledge, self-efficacy to initiate an evaluation, and dialysis center rates of transplant referral and evaluation were assessed before and after this intervention. Results: Of 340 patients approached at 14 centers, 252 (74%) completed the intervention. The intervention increased transplant knowledge (Likert scale 1 to 5: 2.53 [0.10] vs 4.62 [0.05], P < .001) and transplant self-efficacy (2.55 [0.10] to 4.33 [0.07], P < .001. The incidence rate per 100 patient years of transplant evaluations increased 85% (IRR 1.85 [95% CI: 1.02, 3.35], P = .0422) following the intervention. The incidence rates of referrals also increased 56% (IRR 1.56 [95% CI: 1.03, 2.37], P = .0352), while there was a nonsignificant 47% increase in incidence rates of waitlist entries (IRR 1.47 [95% CI: 0.45, 4.74], P = .5210). Conclusion: This dialysis center-based video intervention provides promising preliminary evidence to conduct a large-scale randomized controlled trial to test its effectiveness in increasing self-efficacy of dialysis patients to initiate a transplant evaluation.

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“…These EMRs could deploy non‐disruptive tracking systems that remind clinicians to initiate conversations with CKD patients about kidney transplantation and generate referrals to centers. Integrated systems might also deploy navigators to help patients succeed in completing transplant waitlisting 30 …”

Section: Potential Remedies For Disparities In Preemptive Kidney Tranmentioning

confidence: 99%

Racial disparities in preemptive waitlisting and deceased donor kidney transplantation: Ethics and solutions

Reese

Mohan

King

et al. 2021

American Journal of Transplantation

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Kidney transplantation prior to dialysis, known as “preemptive transplant,” enables patients to live longer and avoid the substantial quality of life burdens due to chronic dialysis. Deceased donor kidneys are a public resource that ought to provide health benefits equitably. Unfortunately, White, better educated, and privately insured patients enjoy disproportionate access to preemptive transplantation using deceased donor kidneys. This problem has persisted for decades and is exacerbated by the first‐come, first‐served approach to kidney allocation for predialysis patients. In this Personal Viewpoint, we describe the diverse barriers to preemptive waitlisting and kidney transplant. The analysis focuses on healthcare system features that particularly disadvantage Black patients, such as the waitlisting eligibility criterion of a single glomerular filtration rate or creatinine clearance ≤20 ml/min, and neglect of wide variation in the rate of progression to end‐stage kidney disease (ESKD) in allocating preemptive transplants. We propose initiatives to improve equity including: (1) standardization of waitlisting eligibility criteria related to kidney function; (2) aggressive education for clinicians about early transplant referral; (3) innovations in electronic medical record capabilities; and (4) rapid status 7 listing by centers. If those initiatives fail, the transplant field should consider eliminating preemptive waitlisting and transplantation with deceased donor kidneys.

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Impact of Navigators on First Visit to a Transplant Center, Waitlisting, and Kidney Transplantation

Abstract: Use of trained kidney transplant recipients as navigators did not increase first visits to a transplant center, waiting list placement, and receipt of deceased or living donor transplants.

Cited by 13 publications

References 22 publications

An opt-out model for kidney transplant referral: The time has come

An opt-out model for kidney transplant referral: The time has come

A Dialysis Center Educational Video Intervention Increases Patient Self-Efficacy and Kidney Transplant Evaluations

Racial disparities in preemptive waitlisting and deceased donor kidney transplantation: Ethics and solutions

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