Protocol of the KTFT-TALK study to reduce racial disparities in kidney transplant evaluation and living donor kidney transplantation

Abstract

Living donor kidney transplantation (LDKT) is the optimal treatment for end-stage kidney disease (ESKD). The evaluation process for a kidney transplant is complex, time consuming, and burdensome to the ESKD patient. Also, race disparities exist in rates of transplant evaluation completion, transplantation, and LDKT. In December 2012 our transplant center implemented a streamlined, one-day evaluation process, dubbed Kidney Transplant Fast Track (KTFT). This paper describes the protocol of a two-part study to evaluate the effectiveness of KTFT at increasing transplant rates (compared to historical controls) and the TALK intervention (Talking About Live Kidney Donation) at increasing LDKT during KTFT. All participants will receive the KTFT evaluation as part of their usual care. Participants will be randomly assigned to TALK versus no-TALK conditions. Patients will undergo interviews at pre-transplant work-up and transplant evaluation. Transplant status will be tracked via medical records. Our aims are to: (1) test the efficacy and cost effectiveness of the KTFT in reducing time to complete kidney transplant evaluation, and increasing kidney transplant rates relative to standard evaluation practices; (2) test whether TALK increases rates of LDKT during KTFT; and (3) determine whether engaging in a streamlined and coordinated-care evaluation experience within the transplant center reduces negative perceptions of the healthcare system. The results of this two-pronged approach will help pave the way for other transplant centers to implement a fast-track system at their sites, improve quality of care by transplanting a larger number of vulnerable patients, and address stark race/ethnic disparities in rates of LDKT.

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

“…The KTFT approach involves completing most or all testing on the same day when candidates arrive for their first pre-transplant clinic appointment. Patients were randomly assigned to the TALK intervention after initial study recruitment [ 134 ]. Another ongoing trial based on the TALK interventions uses an effectiveness-implementation hybrid design involving pre-post intervention evaluation with matched controls to implement a complex culturally-targeted intervention at two transplant centers in Dallas, Texas and Phoenix, Arizona.…”

Persistent regional and racial disparities in nondirected living kidney donation

“…Regardless, the continued racial disparity in NDLD allocation over the course of the study period highlights the need for novel solutions for these organs and warrants consideration as programs for NDLDs develop. There have been recent efforts to decrease disparities in living kidney transplantation targeting both transplant candidates seeking DLDs and streamlining donor evaluation processes, which might be considered for NDLDs as well . These efforts follow the recommendations made by Rodrigue et al in their consensus conference statement by engaging in the community and working to reduce financial burden of living donation.…”

Efficacy of Educational Interventions in Improving Measures of Living-donor Kidney Transplantation Activity: A Systematic Review and Meta-analysis

“…Prospective studies with a diverse patient population, longer follow-ups, and robust outcomes are needed to inform clinical practice; many are currently ongoing. 34,[53][54][55][56][57][58][59] In the meantime, centers could consider simple, less expensive interventions, such as DTA, to educate and assist potential donors and recipients.…”