Making House Calls Increases Living Donor Inquiries and Evaluations for Blacks on the Kidney Transplant Waiting List

Abstract

Background Blacks receive live donor kidney transplantation (LDKT) less often than patients of all other races. We evaluated the effectiveness of educational interventions in removing barriers to LDKT for blacks. Methods Patients were randomized to three interventions in which health educator(s) delivered an intervention to (a) the patient and his/her guests in the patient’s home (House Calls, HC n=54), (b) clusters of patients and their guests in the transplant center (Group-Based, GB n=49), (c) the individual patient alone in the transplant center (Individual Counseling, IC n=49). Results At the 2-year endpoint, 15% (8), 8% (4), and 6% (3) of HC, GB, and IC patients, respectively, received LDKT (p=0.30). HC patients were more likely than GB and IC patients to have at least one donor inquiry (82% vs. 61% vs. 47%, p=0.001) and evaluation (65% vs. 39% vs. 27%, p<0.001). HC patients also were more likely to have higher knowledge, fewer concerns, and higher willingness to talk to others about donation 6 weeks post- intervention. Conclusions These findings underscore the importance of including the patient’s social network in LDKT education and the potential of the HC intervention to reduce racial disparity in LDKT rates.

Living Donor Kidney Transplantation

“…Innovative strategies have been developed to reduce racial/ethnic disparities in LDKT, particularly at the transplant center level. These include the use of transplant navigators (61,62), transplant educators making house calls to patients and their social network (63,64), recruiting and training living donor champions (65), and more effective communication with and education of patients and family members about LDKT and LKD (66)(67)(68)(69). Although these strategies are promising, they have not yet been widely adopted and their utility with patients earlier in their disease process (i.e., before transplant referral) has not yet been established.…”

Cultural competency of a mobile, customized patient education tool for improving potential kidney transplant recipients’ knowledge and decision-making

“…Currently, education programs aimed at increasing interest in transplant do not include individualized, patient and donor-service area (DSA) specific estimates of transplant benefit with each donor type to assist patients in making informed decisions at the time of listing. [12][13][14][15] My Transplant Coach (MTC) is a mobile application (app) that provides a self-contained, patientcentered educational program to fully inform patients with ESRD about the impact of these choices on survival. This report describes the content of MTC, its acceptability and culturally competency in a racially and educationally diverse population, and the impact of MTC on patient knowledge, informed-decision-making, and interest in kidney transplant in a pilot study.…”

Financial Incentives for Living Kidney Donors: Are They Necessary?

“…40 A number of programs designed to educate transplant candidates about living donation and/or facilitate engagement of potential living donors, for example, through use of advocates, have increased rates of living donor transplantation among program participants. [41][42][43][44] Finally, as many as one-third of potentially willing related donors are incompatible with their recipient. 45 Kidney paired donation (KPD) allows living donor kidney transplantation to proceed in such cases.…”