Living renal donation in the African-American community

Transition from donor candidates to live kidney donors: the impact of race and undiagnosed medical disease states

BACKGROUND

Living kidney donors (LKD) allow for increased access to lifesaving organs for transplantation. There is a relative paucity of African American (AA) live kidney donors. The prevalence of medical disease in LKD candidates has not been well studied. We examined the medical limitations to living kidney donation in a large Midwestern transplant center.

METHODS

A total of 2519 adults (age ≥ 18) evaluated as potential LKD (PD) between January 1, 1996 and June 30, 2006 were prospectively followed until evaluation outcome (completed live donation, medical exclusion from live donation, non-medical exclusion from live donation). Logistic regression was used to examine the effect of age on donor exclusion, and chi-square tests were used to compare the likelihood of donor exclusions between racial and gender groups.

RESULTS

Sixty percent of PD were female (n = 1300), and 86% were Caucasian (CA) (n = 1862). Overall, 48.7% of PD who underwent evaluation became LKD. The odds of donation were 52% lower in AA compared to CA (OR 0.48 p < 0.001). Among PD excluded from donation, the most common medical diagnoses were hypertension (HTN) (24.7%), inadequate creatinine clearance (10.6%) and a positive final crossmatch (10.5%). The rate of PD exclusion for obesity was twofold higher in AA compared to CA (12.8% vs. 5.8%, p < 0.001).

CONCLUSIONS

Hypertension in PD is equally significant barrier to living kidney donation in AA and CA whereas obesity is a greater barrier in AA.

A randomized trial of a home-based educational approach to increase live donor kidney transplantation: effects in blacks and whites

BACKGROUND

Blacks are disproportionately affected by chronic kidney disease, but are far less likely to undergo live donor kidney transplantation (LDKT) than whites. We assessed the differential effectiveness in blacks and whites of a home-based (HB) LDKT educational approach.

STUDY DESIGN

A planned secondary analysis of a previously published randomized trial.

SETTING & PARTICIPANTS

132 patients (60 black, 72 white) approved for kidney transplantation at 1 kidney transplant center in the southeastern United States.

INTERVENTION

Assignment to receive either standard clinic-based (CB) transplant education (n = 69) or CB plus an HB (CB + HB) LDKT education program (n = 63). The HB education program was culturally sensitive for blacks, including using a minority health educator, brochures that highlight minority transplant recipients and donors, and discussion of race-specific outcome data.

OUTCOMES

Primary outcomes were proportions of patients with live donor inquiries, evaluations, and transplants 1 year after study participation.

MEASUREMENTS

Medical record and questionnaire data.

RESULTS

69 patients were assigned to the CB group, and 63 to the CB + HB group. After 1 year, there were 96 living donor inquiries (72.7%), 62 living donor evaluations (47.0%), and 54 LDKTs (40.9%). Patients assigned to the CB + HB group were more likely to have had living donor inquiries (odds ratio [OR], 1.7; confidence interval [CI], 1.2 to 3.0), a living donor evaluated (OR, 2.7; CI, 1.4 to 5.4), and LDKT (OR, 3.0; CI, 1.5 to 5.9). The effect was greater in blacks than whites for living donor evaluations and LDKT, but not for living donor inquiries (treatment-by-race interaction, P < 0.001, P < 0.001, and P = 0.8, respectively). Blacks in the CB + HB group were more likely to have had at least 1 living donor inquiry (51.7% versus 77.4%), at least 1 living donor evaluated (17.2% versus 48.4%), and LDKT (13.8% versus 45.2%) than those in the CB group. By comparison, whites in the CB + HB group were more likely to have had at least 1 living donor inquiry (72.5% versus 87.5%), at least 1 living donor evaluated (47.5% versus 71.9%), and LDKT (42.5% versus 59.4%) than those in the CB group.

LIMITATIONS

Single-center study with greater dropout rate in the CB + HB group.

CONCLUSIONS

These results suggest that a culturally sensitive LDKT education program that reaches out to blacks and their social support network can overcome some barriers to LDKT in this population.

Increasing African-American living kidney donors: the feasibility and potential role of nephrology nurses and social workers

This article endeavors to suggest that there may be a better chance of attenuating the gap between the supply and demand of kidney organs for African-American patients, by increasing the number of living donors. Among the multiple issues focused on are the contrasting dynamics between cadaver and living kidney donations with this population. The dual importance of adequate information and providing it in a face-to-face approach with African-American family members is also discussed. The final focus is on the strategic position of nephrology nurses and social workers, in potentially helping to increase the number of African-American living kidney donors.