Racial Disparities in Access to Renal Transplantation — Clinically Appropriate or Due to Underuse or Overuse?

Abstract

Background-Despite abundant evidence of racial disparities in the use of surgical procedures, it is uncertain whether these disparities reflect racial differences in clinical appropriateness or overuse or under-use of care.

Sex Differences and Attitudes toward Living Donor Kidney Transplantation among Urban Black Patients on Hemodialysis

“…Whereas our overall percentage of black patients interested in either DDKT or LDKT (72.3%) was almost identical to an earlier study (2), our study diverges from previous studies (2,4,7,(13)(14)(15) in that significantly more black men (82.8%) wanted LDKT compared with women (58.6%). Although there is some evidence that age may affect attitudes toward transplantation (2), younger women were less likely to want LDKT compared with younger men.…”

“…However, LDKT is underused by several disadvantaged groups, including women and blacks. Although Ayanian et al (12) found that women (especially black women) were less likely to want LDKT, recent studies of patients presenting for transplant evaluation have found racial differences but not sex differences in wanting LDKT (2,4,7,(13)(14)(15). It is possible that sex differences in wanting LDKT might be underestimated when only patients presenting for transplant evaluation are studied.…”

“…For the majority of patients with ESRD, living donor kidney transplantation (LDKT) is the treatment of choice (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). However, LDKT is underused by several disadvantaged groups, including women and blacks.…”

The Interplay of Socioeconomic Status, Distance to Center, and Interdonor Service Area Travel on Kidney Transplant Access and Outcomes

“…The effect of sociodemographic factors such as race and ethnicity on kidney transplantation has been the subject of significant evaluation over the past 2 decades (17,18). African Americans face barriers in referral to transplant (12,19), completion of the evaluation and listing (17,20), and obtaining a deceased donor allograft in part because of HLA matching.…”

Socioeconomic Factors in Access to Renal Transplantation

“…Traditionally, disparities in access to renal transplantation have been described extensively in terms of race, gender, income and geographic location [1][2][3][4]. End-stage renal disease (ESRD) is known to be a major cause of morbidity and mortality in the United States and worldwide [5].…”