Living Donor Transplant Education for African American Patients with End-Stage Renal Disease

Abstract

Living ACTS is effective at increasing and maintaining knowledge about LDKT among African American patients with end-stage renal disease who are considering transplant.

Transplant Center Patient Navigator and Access to Transplantation among High-Risk Population

“…In a prior study focusing on disadvantaged populations to improve kidney transplant access, health educators were randomized to visit black patients with ESKD and guests in their homes, which resulted in a trend toward increased living donor transplant and increased knowledge and willingness to discuss transplantation (37). Arriola et al (38) also found that a culturally sensitive educational intervention at a transplant center increased knowledge and willingness to talk to patients' families about transplant; however, key steps, such as waitlisting and transplant, were not examined. There are several explanations for why we did not observe a difference in waitlisting among intervention (5) 9 (5) 10 (5) 0.89 Figure 2.…”

“…Larger, multicenter studies testing the effectiveness of a patient navigator may be warranted, particularly because the absolute effect of the navigator was small after the 500 days (15 versus five waitlisting events). Perhaps future studies should administer multiple interventions along with patient navigation, such as educational interventions that take place in either a patient's home (21) or the dialysis facility (39) and/ or culturally sensitive education within a transplant center focusing on living donor transplant (38), to potentially have a synergistic effect on waitlisting and help address the major barriers faced by this population. Larger studies with longer follow-up could also examine important outcomes beyond waitlisting, including receipt of a living or deceased donor transplant.…”

“…Navigator duties included transplant education with an emphasis on living donor transplant, because previous research has shown there are greater racial and socioeconomic disparities in living versus deceased donor transplant and living donation could reduce transplant waiting times (29)(30)(31)(32); assisting with scheduling, appointment reminders, financial aid, transportation, and interpretative services for non-native English speakers; providing social support, including referrals to support groups and community resources; and serving as a liaison between the patient and other members of the patient's care team and between the transplant center and outside health care and social service organizations, such as the patient's dialysis facility. The navigator provided educational materials from the Emory Transplant Center and the National Kidney Fund, contact information for the Living Donor Hotline to promote living donor transplant, financial resources from the Georgia Transplant Foundation regarding financial assistance, Georgia Crisis Hotline information for patients with mental health issues, and pamphlets for weight loss, drug rehabilitation, or smoking cessation as needed.…”

Decision Aids to Increase Living Donor Kidney Transplantation

“…While some of these decision aids overlap across categories, we broadly classified the 12 decision aids across the following types: 1) comprehensive LDKT education, 2) culturally sensitive, targeted to specific audience, 3) recipient education, 4) potential donor recruitment and education, and 5) healthcare provider education. Four of these aids have completed evaluation and demonstrated effectiveness [45–48]. Six are undergoing effectiveness testing [49–54] (Table 2).…”

“…Living About Choices in Transplantation and Sharing (Living ACTS) [45] is a decision aid developed using the IPDAS Guidelines and aimed at overcoming communication barriers related to LDKT that are culturally-sensitive to African Americans. Living ACTS was adapted from a community project with local churches aimed to improve the public commitment to deceased donation [61].…”