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Regev-Epstein LC, Frishberg Y, Davidovits M, Landau D, Magen D, Weismann I, Stern-Zimmer M, Beckerman P, Keinan-Boker L, Calderon-Margalit R, Vivante A. Dialysis in Israeli Children between 1990 and 2020: Trends and International Comparisons. Clin J Am Soc Nephrol 2023; 18:363-373. [PMID: 36722361 PMCID: PMC10103217 DOI: 10.2215/cjn.0000000000000063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/22/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Childhood kidney failure is a rare condition with worldwide clinical variability. We used a nationwide multicenter analysis to study the pretransplant course of the entire Israeli pediatric kidney failure population over 30 years. METHODS In this nationwide, population-based, historical cohort study, we analyzed medical and demographic data of all children treated with KRT and reported to the Israeli kidney failure registry in 1990-2020. Statistical analysis was performed with incidence rate corrected for age, ethnicity, and calendar year, using the appropriate age-related general population as denominator. RESULTS During the last 30 years, childhood incidence of kidney failure decreased. Average incidence in 2015-2019 was 9.1 cases per million age-related population (pmarp). Arab and Druze children exhibited higher kidney failure incidence rates than Jewish children (18.4 versus 7.0 cases pmarp for minorities versus Jews). The most common kidney failure etiologies among Arab and Jewish children were congenital anomalies of the kidney and urinary tract (approximately 27%), followed by cystic kidney diseases among Arab children (13%) and glomerulonephritis among Jewish children (16%). The most common etiology among Druze children was primary hyperoxaluria type 1 (33%). Israel's national health insurance provides access to primary health care to all citizens. Accordingly, waiting time for deceased-donor transplantation was equal between all ethnicities. Living-donor kidney transplantation rates among minority populations remained low in comparison with Jews over the entire study period. Although all patient groups demonstrated improvement in survival, overall survival rates were mainly etiology dependent. CONCLUSIONS In Israel, Arab and Druze children had a higher incidence of kidney failure, a unique etiological distribution, and a lower rate of living-donor kidney transplantations compared with Jewish children.
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Affiliation(s)
- Lilach C. Regev-Epstein
- Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Department of Pediatric Nephrology, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Yaacov Frishberg
- Division of Pediatric Nephrology, Shaare Zedek Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Miriam Davidovits
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniel Landau
- Institute of Nephrology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Daniella Magen
- Pediatric Nephrology Institute, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel
| | - Irit Weismann
- Pediatric Nephrology Unit, Galilee Medical Center, Nahariya, Israel
| | - Michal Stern-Zimmer
- Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
| | - Pazit Beckerman
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Institute of Nephrology and Hypertension, Sheba Medical Center, Tel Hashomer, Israel
| | - Lital Keinan-Boker
- Israel Center for Disease Control, Ramat Gan, Israel
- School of Public Health, University of Haifa, Haifa, Israel
| | | | - Asaf Vivante
- Department of Pediatrics B, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel-Hashomer, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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2
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Loor JM, Judd NS, Rice CM, Perea DD, Croswell E, Singh PP, Unruh M, Zhu Y, Sehgal AR, Goff SL, Bryce CL, Myaskovsky L. Protocol for the AKT-MP trial: Access to Kidney Transplantation in Minority Populations. Contemp Clin Trials Commun 2022; 30:101015. [PMID: 36246997 PMCID: PMC9562954 DOI: 10.1016/j.conctc.2022.101015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 09/02/2022] [Accepted: 10/01/2022] [Indexed: 11/01/2022] Open
Abstract
Background Kidney transplant (KT) is the optimal treatment for kidney failure (KF), and although completion of KT evaluation is an essential step in gaining access to transplantation, the process is lengthy, time consuming, and burdensome. Furthermore, despite similar referral rates to non-Hispanic Whites, both Hispanic/Latinos and American Indians are less likely to be wait-listed or to undergo KT. Methods The Access to Kidney Transplantation in Minority Populations (AKT-MP) Trial compares two patient-centered methods to facilitate KT evaluation: kidney transplant fast track (KTFT), a streamlined KT evaluation process; and peer navigators (PN), a peer-assisted evaluation program that incorporates motivational interviewing. This pragmatic randomized trial will use a comparative effectiveness approach to assess whether KTFT or PN can help patients overcome barriers to transplant listing. We will randomly assign patients to the two conditions. We will track participants' medical records and conduct surveys prior to their initial evaluation clinic visit and again after they complete or discontinue evaluation. Conclusion Our aims are to (1) compare KTFT and PN to assess improvements in kidney transplant (KT) related outcomes and cost effectiveness; (2) examine how each approach effects changes in cultural/contextual factors, KT concerns, KT knowledge, and KT ambivalence; and (3) develop a framework for widespread implementation of either approach. The results of this trial will provide key information for facilitating the evaluation process, improving patient care, and decreasing disparities in KT.
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Affiliation(s)
- Jamie M. Loor
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States
| | - Nila S. Judd
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States
| | - Claudia M. Rice
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States
| | - Diana D. Perea
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States
| | - Emilee Croswell
- Department of Psychiatry, University of Pittsburgh, United States
| | - Pooja P. Singh
- Department of Internal Medicine, University of New Mexico, School of Medicine, United States
| | - Mark Unruh
- Department of Internal Medicine, University of New Mexico, School of Medicine, United States
| | - Yiliang Zhu
- Department of Internal Medicine, University of New Mexico, School of Medicine, United States
| | - Ashwini R. Sehgal
- Department of Medicine, Case Western Reserve University, United States
| | - Sarah L. Goff
- Department of Health Policy and Management, University of Massachusetts, Amherst, United States
| | - Cindy L. Bryce
- Department of Health Policy and Management, University of Pittsburgh, School of Public Health, United States
| | - Larissa Myaskovsky
- Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States,Department of Internal Medicine, University of New Mexico, School of Medicine, United States,Corresponding author. Center for Healthcare Equity in Kidney Disease (CHEK-D), University of New Mexico Health Science Center, United States.
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3
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Lentine KL, Pastan S, Mohan S, Reese PP, Leichtman A, Delmonico FL, Danovitch GM, Larsen CP, Harshman L, Wiseman A, Kramer HJ, Vassalotti J, Joseph J, Longino K, Cooper M, Axelrod DA. A Roadmap for Innovation to Advance Transplant Access and Outcomes: A Position Statement From the National Kidney Foundation. Am J Kidney Dis 2021; 78:319-332. [PMID: 34330526 DOI: 10.1053/j.ajkd.2021.05.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 05/01/2021] [Indexed: 02/07/2023]
Abstract
Over the past 65 years, kidney transplantation has evolved into the optimal treatment for patients with kidney failure, dramatically reducing suffering through improved survival and quality of life. However, access to transplant is still limited by organ supply, opportunities for transplant are inequitably distributed, and lifelong transplant survival remains elusive. To address these persistent needs, the National Kidney Foundation convened an expert panel to define an agenda for future research. The key priorities identified by the panel center on the needs to develop and evaluate strategies to expand living donation, improve waitlist management and transplant readiness, maximize use of available deceased donor organs, and extend allograft longevity. Strategies targeting the critical goal of decreasing organ discard that warrant research investment include educating patients and clinicians about potential benefits of accepting nonstandard organs, use of novel organ assessment technologies and real-time decision support, and approaches to preserve and resuscitate allografts before implantation. The development of personalized strategies to reduce the burden of lifelong immunosuppression and support "one transplant for life" was also identified as a vital priority. The panel noted the specific goal of improving transplant access and graft survival for children with kidney failure. This ambitious agenda will focus research investment to promote greater equity and efficiency in access to transplantation, and help sustain long-term benefits of the gift of life for more patients in need.
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Affiliation(s)
- Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St Louis, MO.
| | - Stephen Pastan
- Department of Medicine, Emory Transplant Center, Atlanta, GA
| | - Sumit Mohan
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - Peter P Reese
- Renal-Electrolyte and Hypertension Division, University of Pennsylvania, Philadelphia, PA
| | - Alan Leichtman
- Department of Medicine, University of Michigan, Ann Arbor, MI
| | | | | | | | - Lyndsay Harshman
- Department of Pediatrics, University of Iowa Transplant Institute, Iowa City, IA
| | - Alexander Wiseman
- Department of Medicine, Centura Health-Porter Adventist Hospital, Aurora, CO
| | | | - Joseph Vassalotti
- National Kidney Foundation, New York, NY; Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | | | - Matthew Cooper
- Department of Surgery, Medstar Georgetown Transplant Institute, Washington, DC
| | - David A Axelrod
- Department of Surgery, University of Iowa Transplant Institute, Iowa City, IA
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4
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Efficacy of Educational Interventions in Improving Measures of Living-donor Kidney Transplantation Activity: A Systematic Review and Meta-analysis. Transplantation 2020; 103:2566-2575. [PMID: 30946222 DOI: 10.1097/tp.0000000000002715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND To address patient-level barriers to living-donor kidney transplantation (LDKT), centers have implemented educational interventions. Recently, some have highlighted several gaps in knowledge and lack of evidence of efficacy of these interventions. No review has synthesized the available data. METHODS We conducted a systematic review and meta-analysis of studies conducted to increase measures of LDKT. Outcomes of interest were LDKT rates, donor evaluation, donor contact/inquiry, total transplantation rates, and change in knowledge scores and pursuit behaviors. A literature search was conducted across 7 databases from inception until 2017. Educational interventions were a decision/teaching aid alone or with personalized sessions. Comparator was another intervention or nonspecific education. Random effects meta-analysis was performed to pool risk ratios (RRs) across studies. RESULTS Of the 1813 references, 15 met the inclusion criteria; 9 were randomized control trials. When compared with nonspecific education, interventions increased LDKT rates (RR = 2.54; 95% confidence interval [CI], 1.49-4.35), donor evaluation (RR = 3.82; 95% CI, 1.91-7.64), and donor inquiry/contact (RR = 2.41; 95% CI, 1.53-3.80), but not total transplants (RR = 1.24; 95% CI, 0.96-1.61). Significant increased mean knowledge scores postintervention was noted, and most showed favorable trends in pursuit behaviors. Quality across the studies was mixed and sometimes difficult to assess. The biggest limitations were small sample size, selection bias, and short follow-ups. CONCLUSIONS Educational interventions improve measures of LDKT activity; however, current literature is heterogeneous and at risk of selection bias. Prospective studies with diverse patient populations, longer follow-ups, and robust outcomes are needed to inform clinical practice.
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Serrano OK, Matas AJ. Retransplant Outcomes Compared With First Kidney Transplants: Important Observations Not Reported in the Scientific Registry of Transplant Recipients Annual Report. EXP CLIN TRANSPLANT 2019; 18:48-52. [PMID: 30806202 DOI: 10.6002/ect.2018.0244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Twice per year, the Scientific Registry of Transplant Recipients provides risk-adjusted center-specific reports of 1- and 3-year outcomes. In addition, the Registry reports 10-year aggregate survival outcomes for kidney transplant recipients. However, in this annual report, no distinction is made between outcomes of patients with a first transplant versus those with retransplants. MATERIALS AND METHODS We analyzed data from the Scientific Registry of Transplant Recipients between 1992 and 2015 to determine outcomes after a 1st, 2nd, or ≥ 3rd kidney transplant. Recipients were stratified by donor source (living vs deceased) and transplant number, and rates of graft failure, death-censored graft failure, and death with functioning graft were determined. RESULTS From 1992 to 2015, rates of graft failure and death-censored graft failure at 6 months, 1 year, 3 years, 5 years, and 10 years decreased; however, long-term rates of death with functioning graft were unchanged. Outcomes for 1st and 2nd kidney transplant were better than outcomes for ≥ 3rd transplant. CONCLUSIONS It would be extremely valuable if the Scientific Registry of Transplant Recipients could present stratified analyses that would account for a host of factors, including organ sequence, which tend to vary by center. The presentation of risk-adjusted outcomes in the annual Registry report could include a more comprehensive assessment of program performance. Such information would be extremely useful for transplant centers, patients, and their support networks, organ procurement organizations, and other transplant stakeholders.
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Affiliation(s)
- Oscar K Serrano
- From the Department of Surgery, Division of Transplantation, University of Minnesota, Minneapolis, Minnesota, USA
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6
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Bert F, Gualano MR, Scozzari G, Alesina M, Amoroso A, Siliquini R. YouTube ®: An ally or an enemy in the promotion of living donor kidney transplantation? Health Informatics J 2018; 24:103-110. [DOI: 10.1177/1460458216654514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Abstract
The aim of the study is to evaluate the availability and accuracy of the existing Italian-language medical information about living donor kidney transplantation on YouTube®. For each video, several data were collected, and each video was classified as “useful,” “moderately useful” and “not useful.” Globally, the search resulted in 306 videos: 260 were excluded and 46 included in the analysis. The main message conveyed by the video was positive in 28 cases (60.9%), neutral in 16 (34.8%) and negative in 2 (4.4%). The mean amount of visualizations was 3103.5 (range: 17–90,133) and the mean amount of “likes” 2.7 (range: 0–28). Seven videos (15.2%) were classified as “useful,” 21 (45.7%) as “moderately useful” and 18 (39.1%) as “not useful.” This study showed that a very few videos in Italian about living donor kidney transplantation are available on YouTube, with only 15 percent of them containing useful information for the general population.
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7
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Hunt HF, Rodrigue JR, Dew MA, Schaffer RL, Henderson ML, Bloom R, Kacani P, Shim P, Bolton L, Sanchez W, Lentine KL. Strategies for Increasing Knowledge, Communication, and Access to Living Donor Transplantation: an Evidence Review to Inform Patient Education. CURRENT TRANSPLANTATION REPORTS 2018; 5:27-44. [PMID: 30873335 DOI: 10.1007/s40472-018-0181-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Purpose of review Inadequate knowledge of the benefits, risks and opportunities for living donation is an important, potentially modifiable barrier to living donor transplantation. We assessed the current state of the evidence regarding strategies to increase knowledge, communication and access to living donor transplantation, as reported in peer-reviewed medical literature. Recent Findings Nineteen studies were reviewed, categorized as programs evaluated in randomized controlled trials (8 studies) and programs supported by observational (non-randomized) studies (11 studies). Content extraction demonstrated that comprehensive education about living donation and living donor transplantation involves multiple learners - the transplant candidate, potential living donors, and social support networks - and requires communicating complex information about the risks and benefits of donation, transplantation and alternative therapies to these different audiences. Transplant centers can help transplant patients learn about living donor transplantation through a variety of formats and modalities, including center-based, home-based and remote technology-based education, outreach to dialysis centers, and social media. Evaluation of these strategies and program themes informed a new Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) public education brochure. Summary Increasing transplant candidate knowledge and comfort in talking about living donation and transplantation can reduce educational barriers to pursuit of living donor transplants. Ongoing efforts are needed to develop, refine and disseminate educational programs to help improve transplant access for more patients in need of organ donors.
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Affiliation(s)
- Heather F Hunt
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,LIVE ON Organ Donation, Inc., Longmeadow, MA
| | - James R Rodrigue
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Beth Israel Deaconess Transplant Institute, Boston, MA
| | - Mary Amanda Dew
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,University of Pittsburgh School of Medicine and Medical Center, Pittsburgh, PA
| | - Randolph L Schaffer
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Scripps Clinic, La Jolla, CA
| | - Macey L Henderson
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Johns Hopkins University, Transplant Center & School of Nursing, Baltimore, MD
| | - Randee Bloom
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA
| | - Patrick Kacani
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA
| | - Pono Shim
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA
| | - Lee Bolton
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA
| | - William Sanchez
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Mayo Clinic, Rochester, MN
| | - Krista L Lentine
- Organ Procurement and Transplantation Network (OPTN)/United Network for Organ Sharing (UNOS) Living Donor Committee, Richmond, VA.,Saint Louis University School of Medicine & Transplant Center, St. Louis, MO
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8
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St Clair Russell J, Boulware LE. End-stage renal disease treatment options education: What matters most to patients and families. Semin Dial 2018; 31:122-128. [PMID: 29315798 DOI: 10.1111/sdi.12665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Treatment modality education can offer many important benefits to patients and their families. Evidence suggests such education can increase use of home dialysis, reduce catheter use, decrease 90-day mortality, and increase transplantation. While these benefits are encouraging, not all patients are offered options education and when they are, it may not be presented in a way that is immediately applicable to them and their lives. Furthermore, little is known regarding specific characteristics (e.g. format such as group or individual or in-person or online, duration, teaching methods, location, content) of educational programs that are most successful. No single approach has emerged as a best practice. In the absence of such evidence, adult learning principles, such as involving patients and families in the development programs and materials, can serve as a guide for educational development. Adult learning principles can enhance options education, evolving them from information delivery to a person-centered, values-based endeavor that helps match treatment to values and lifestyle.
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Affiliation(s)
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA
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Wu DA, Robb ML, Watson CJE, Forsythe JLR, Tomson CRV, Cairns J, Roderick P, Johnson RJ, Ravanan R, Fogarty D, Bradley C, Gibbons A, Metcalfe W, Draper H, Bradley AJ, Oniscu GC. Barriers to living donor kidney transplantation in the United Kingdom: a national observational study. Nephrol Dial Transplant 2018; 32:890-900. [PMID: 28379431 PMCID: PMC5427518 DOI: 10.1093/ndt/gfx036] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 02/09/2017] [Indexed: 02/06/2023] Open
Abstract
Background. Living donor kidney transplantation (LDKT) provides more timely access to transplantation and better clinical outcomes than deceased donor kidney transplantation (DDKT). This study investigated disparities in the utilization of LDKT in the UK. Methods. A total of 2055 adults undergoing kidney transplantation between November 2011 and March 2013 were prospectively recruited from all 23 UK transplant centres as part of the Access to Transplantation and Transplant Outcome Measures (ATTOM) study. Recipient variables independently associated with receipt of LDKT versus DDKT were identified. Results. Of the 2055 patients, 807 (39.3%) received LDKT and 1248 (60.7%) received DDKT. Multivariable modelling demonstrated a significant reduction in the likelihood of LDKT for older age {odds ratio [OR] 0.11 [95% confidence interval (CI) 0.08–0.17], P < 0.0001 for 65–75 years versus 18–34 years}; Asian ethnicity [OR 0.55 (95% CI 0.39–0.77), P = 0.0006 versus White]; Black ethnicity [OR 0.64 (95% CI 0.42–0.99), P = 0.047 versus White]; divorced, separated or widowed [OR 0.63 (95% CI 0.46–0.88), P = 0.030 versus married]; no qualifications [OR 0.55 (95% CI 0.42–0.74), P < 0.0001 versus higher education qualifications]; no car ownership [OR 0.51 (95% CI 0.37–0.72), P = 0.0001] and no home ownership [OR 0.65 (95% CI 0.85–0.79), P = 0.002]. The odds of LDKT varied significantly between countries in the UK. Conclusions. Among patients undergoing kidney transplantation in the UK, there are significant age, ethnic, socio-economic and geographic disparities in the utilization of LDKT. Further work is needed to explore the potential for targeted interventions to improve equity in living donor transplantation.
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Affiliation(s)
- Diana A Wu
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Christopher J E Watson
- Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - John L R Forsythe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.,NHS Blood and Transplant, Bristol, UK
| | | | - John Cairns
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Paul Roderick
- Primary Care and Population Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | | | - Rommel Ravanan
- Department of Renal Medicine, Southmead Hospital, Bristol, UK
| | - Damian Fogarty
- Regional Nephrology and Transplant Centre, Belfast Health and Social Care Trust, Belfast, UK
| | - Clare Bradley
- Health Psychology Research Unit, Royal Holloway, University of London, Egham, UK
| | - Andrea Gibbons
- Health Psychology Research Unit, Royal Holloway, University of London, Egham, UK
| | - Wendy Metcalfe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Heather Draper
- Health Sciences, University of Warwick, Conventry, UK (author has moved institutions since acceptance of the article)
| | - Andrew J Bradley
- Department of Surgery, University of Cambridge and the NIHR Cambridge Biomedical Research Centre, Cambridge, UK
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10
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Purnell TS, Luo X, Cooper LA, Massie AB, Kucirka LM, Henderson ML, Gordon EJ, Crews DC, Boulware LE, Segev DL. Association of Race and Ethnicity With Live Donor Kidney Transplantation in the United States From 1995 to 2014. JAMA 2018; 319:49-61. [PMID: 29297077 PMCID: PMC5833543 DOI: 10.1001/jama.2017.19152] [Citation(s) in RCA: 189] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
IMPORTANCE Over the past 2 decades, there has been increased attention and effort to reduce disparities in live donor kidney transplantation (LDKT) for black, Hispanic, and Asian patients with end-stage kidney disease. The goal of this study was to investigate whether these efforts have been successful. OBJECTIVE To estimate changes over time in racial/ethnic disparities in LDKT in the United States, accounting for differences in death and deceased donor kidney transplantation. DESIGN, SETTING, AND PARTICIPANTS A secondary analysis of a prospectively maintained cohort study conducted in the United States of 453 162 adult first-time kidney transplantation candidates included in the Scientific Registry of Transplant Recipients between January 1, 1995, and December 31, 2014, with follow-up through December 31, 2016. EXPOSURES Race/ethnicity. MAIN OUTCOMES AND MEASURES The primary study outcome was time to LDKT. Multivariable Cox proportional hazards and competing risk models were constructed to assess changes in racial/ethnic disparities in LDKT among adults on the deceased donor kidney transplantation waiting list and interaction terms were used to test the statistical significance of temporal changes in racial/ethnic differences in receipt of LDKT. The adjusted subhazard ratios are estimates derived from the multivariable competing risk models. Data were categorized into 5-year increments (1995-1999, 2000-2004, 2005-2009, 2010-2014) to allow for an adequate sample size in each analytical cell. RESULTS Among 453 162 adult kidney transplantation candidates (mean [SD] age, 50.9 [13.1] years; 39% were women; 48% were white; 30%, black; 16%, Hispanic; and 6%, Asian), 59 516 (13.1%) received LDKT. Overall, there were 39 509 LDKTs among white patients, 8926 among black patients, 8357 among Hispanic patients, and 2724 among Asian patients. In 1995, the cumulative incidence of LDKT at 2 years after appearing on the waiting list was 7.0% among white patients, 3.4% among black patients, 6.8% among Hispanic patients, and 5.1% among Asian patients. In 2014, the cumulative incidence of LDKT was 11.4% among white patients, 2.9% among black patients, 5.9% among Hispanic patients, and 5.6% among Asian patients. From 1995-1999 to 2010-2014, racial/ethnic disparities in the receipt of LDKT increased (P < .001 for all statistical interaction terms in adjusted models comparing white patients vs black, Hispanic, and Asian patients). In 1995-1999, compared with receipt of LDKT among white patients, the adjusted subhazard ratio was 0.45 (95% CI, 0.42-0.48) among black patients, 0.83 (95% CI, 0.77-0.88) among Hispanic patients, and 0.56 (95% CI, 0.50-0.63) among Asian patients. In 2010-2014, compared with receipt of LDKT among white patients, the adjusted subhazard ratio was 0.27 (95% CI, 0.26-0.28) among black patients, 0.52 (95% CI, 0.50-0.54) among Hispanic patients, and 0.42 (95% CI, 0.39-0.45) among Asian patients. CONCLUSIONS AND RELEVANCE Among adult first-time kidney transplantation candidates in the United States who were added to the deceased donor kidney transplantation waiting list between 1995 and 2014, disparities in the receipt of live donor kidney transplantation increased from 1995-1999 to 2010-2014. These findings suggest that national strategies for addressing disparities in receipt of live donor kidney transplantation should be revisited.
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Affiliation(s)
- Tanjala S. Purnell
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
| | - Xun Luo
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Lisa A. Cooper
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Allan B. Massie
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Lauren M. Kucirka
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Macey L. Henderson
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Elisa J. Gordon
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Deidra C. Crews
- Johns Hopkins Center for Health Equity, Johns Hopkins University, Baltimore, Maryland
- Division of Nephrology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - L. Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina
| | - Dorry L. Segev
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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11
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Barnieh L, Collister D, Manns B, Lam NN, Shojai S, Lorenzetti D, Gill JS, Klarenbach S. A Scoping Review for Strategies to Increase Living Kidney Donation. Clin J Am Soc Nephrol 2017; 12:1518-1527. [PMID: 28818845 PMCID: PMC5586566 DOI: 10.2215/cjn.01470217] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 05/12/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES The literature on strategies to increase the number of potential living kidney donors is extensive and has yet to be characterized. Scoping reviews are a novel methodology for systematically assessing a wide breadth of a given body of literature and may be done before conducting a more targeted systematic review. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We performed a scoping review and summarized the evidence for existing strategies to increase living kidney donation. RESULTS Our review identified seven studies that tested interventions using rigorous methods (i.e., randomized, controlled trials) and outcome measures, all of which focused on using education targeted at potential recipients to increase living donation. Of these, two studies that targeted the potential recipients' close social network reported statistically significant results. Other interventions were identified, but their effect was assessed through quasiexperimental or observational study designs. CONCLUSIONS We identified an important gap in the literature for evidence-based strategies to increase living kidney donation. From the limited data available, strategies directed at potential recipients and their social networks are the most promising. These results can inform transplant programs that are considering strategies to increase living kidney donation and highlight the need for conduct of high-quality study to increase living donation.
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Affiliation(s)
- Lianne Barnieh
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - David Collister
- Division of Nephrology, Department of Medicine, McMaster University, St. Joseph’s Hospital, Hamilton, Ontario, Canada
| | - Braden Manns
- Department of Community Health Sciences and
- Department of Medicine, Institute of Public Health and Libin Cardiovascular Institute, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada; and
| | - Ngan N. Lam
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Soroush Shojai
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Diane Lorenzetti
- Department of Medicine, Institute of Public Health and Libin Cardiovascular Institute, Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada; and
| | - John S. Gill
- Division of Nephrology, Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Scott Klarenbach
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
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12
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Rodrigue JR, Feranil M, Lang J, Fleishman A. Readability, content analysis, and racial/ethnic diversity of online living kidney donation information. Clin Transplant 2017. [PMID: 28640438 DOI: 10.1111/ctr.13039] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
More than three-fourths of adults in the USA use the Internet to access health-related information. Adults exploring the possibility of living donation should have access to online content that is readable and comprehensive. We simulated a search of online information about living kidney donation and evaluated readability, topics covered, and racial/ethnic diversity of 21 websites meeting inclusion criteria (eg, hosted by a nonprofit or patient advocacy organization, English content, based in USA). Using standard readability metrics, 62% of sites were classified as "Difficult to read" and none achieved the recommended reading level of sixth grade. On average, websites covered 18.5 (62%) of 30 recommended information topics (range: 7 to 28) and only 2.1 (23%) of 9 racial/ethnic diversity items (range: 0 to 6). Overall, the most common nonprofit or patient advocacy organization websites do not meet the readability standards established by the National Institutes of Health and the American Medical Association, many lack fundamental information about living kidney donation, and most are not racially/ethnically diverse. We encourage the transplant community to consider playing a more active role in improving the overall quality of online information disseminated to the general public. Further, there is a need to more critically examine the accuracy of online living donation content in future investigations.
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Affiliation(s)
- James R Rodrigue
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Departments of Surgery and Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Mario Feranil
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jenna Lang
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Aaron Fleishman
- Center for Transplant Outcomes and Quality Improvement, Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA
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13
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Bornemann K, Croswell E, Abaye M, Bryce CL, Chang CCH, Good DS, Freehling Heiles CA, Dew MA, Boulware LE, Tevar AD, Myaskovsky L. Protocol of the KTFT-TALK study to reduce racial disparities in kidney transplant evaluation and living donor kidney transplantation. Contemp Clin Trials 2016; 53:52-59. [PMID: 27923612 DOI: 10.1016/j.cct.2016.11.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/17/2016] [Accepted: 11/27/2016] [Indexed: 01/18/2023]
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.
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Affiliation(s)
- Kellee Bornemann
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Emilee Croswell
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Menna Abaye
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Cindy L Bryce
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Chung-Chou H Chang
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Health Equity Research and Promotion, Pittsburgh VA Healthcare System, Pittsburgh, PA, United States; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - Deborah S Good
- Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | | | - Mary Amanda Dew
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States; Department of Psychology, University of Pittsburgh, PA, United States; Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - L Ebony Boulware
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, United States
| | - Amit D Tevar
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States; Starzl Transplant Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - Larissa Myaskovsky
- Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Health Equity Research and Promotion, Pittsburgh VA Healthcare System, Pittsburgh, PA, United States; Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States; Center for Bioethics and Health Law, University of Pittsburgh, Pittsburgh, PA, United States.
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14
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Burroughs TE, Waterman AD, Hong BA. One Organ Donation, Three Perspectives: Experiences of Donors, Recipients, and Third Parties with Living Kidney Donation. Prog Transplant 2016; 13:142-50. [PMID: 12841522 DOI: 10.1177/152692480301300212] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Although living kidney donors' experiences with donation have been studied, questions of potential bias in retrospective donor reports remain. This study examined the experience of living kidney donation from 3 perspectives: those of the donor, the recipient, and a third party involved with the donation (ie, a donor triad). Surveys were completed with 174 donor triads to examine triad members' perceptions of donors' concerns before transplantation, whether these concerns came true after transplantation, the donors' experiences with surgery and recovery, and whether they would make the same decision again today. Triad members all agreed that donors were highly satisfied with their donation experience and that the relationship between recipient and donor improved after transplantation. Although recipients and third parties correctly identified the donors' primary concerns, they underestimated the prevalence of 16 of 18 donor concerns, including the donors' willingness to make the same decision again. Recipients also overestimated how painful and difficult the surgery and recovery were for donors. The results suggest that retrospective studies of donors may not be marred by significant misreporting or memory biases and that better education about the donation experience for the entire donor triad might provide better social support for donors, reduce recipients' guilt about donors' pain, and increase donation rates overall.
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15
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Waterman AD, Covelli T, Caisley L, Zerega W, Schnitzler M, Adams D, Hong BA. Potential Living Kidney Donors' Health Education Use and Comfort with Donation. Prog Transplant 2016; 14:233-40. [PMID: 15495783 DOI: 10.1177/152692480401400309] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context Much living kidney donation research focuses on actual donors rather than all donors who are evaluated by the transplant center. Objective To determine (1) what concerns and benefits potential donors saw possible from donation, (2) how they educated themselves before contacting the transplant center, and (3) who were the most comfortable donors. Design A telephone survey of 91 potential donors before transplant evaluation. Setting Barnes-Jewish Hospital Transplant Center in St Louis, Mo. Main Outcome Measures Willingness and comfort donating, key concerns and perceived benefits to donation, hours of transplant-related education. Results On a 7-point scale, potential donors were very willing (mean=6.65, SD=0.95) and comfortable (mean=6.31, SD=1.12) donating. They were most concerned that their recipients would die if they could not donate, the evaluation and surgery would be anxiety provoking or painful, and they did not understand what donation would require. Donors previously spent an average of 6 hours reading health resources and 32 hours discussing donation. Using logistic regression, those donors with 0 to 4 concerns (odds ratio=7.1, 95% confidence interval [CI], 2.2–23.16), more than 5 benefits (odds ratio=3.7, 95% CI, 1.2–11.0), and who were family members (odds ratio=4.7, 95% CI, 1.4–15.8) were more likely to be extremely comfortable donating compared to others. Conclusions Before evaluation, most potential donors are willing to donate because they think that it is important to improve the health of a loved one. Their knowledge of donation varies and they need clear information about medical testing and support coping with any negative donation outcomes.
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Affiliation(s)
- Amy D Waterman
- Washington University School of Medicine, St Louis, Mo, USA
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16
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Waterman AD, Stanley SL, Covelli T, Hazel E, Hong BA, Brennan DC. Living Donation Decision Making: Recipients' Concerns and Educational Needs. Prog Transplant 2016; 16:17-23. [PMID: 16676669 DOI: 10.1177/152692480601600105] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context Despite the advantages of living donor transplantation, evidence suggests that some potential recipients with living donors have psychological concerns that prevent them from pursuing living donation. Addressing these concerns through education may increase the rates of living donation. Objective To understand the psychological barriers and educational needs of potential kidney recipients regarding living donation. Subjects and Design Qualitative focus group study of kidney transplant recipients, donors, and family members to explore their assessment of the advantages of dialysis and deceased donor transplantation over living donation, their concerns about living donation, and what types of living donation education would be most helpful. Results Kidney recipients reported that they might not pursue living donation because they felt guilty and indebted to the donor, did not want to harm or inconvenience the donor, did not want to accept a kidney that a family member might need later, and did not want to disappoint the donor if the kidney failed. Recipients were generally unaware that donors could personally benefit from donating and would rather wait for donor volunteers than ask anyone directly. Both donors and recipients thought that training on how to make the donation request and education about living donors' motivations for donation and transplant experience could help more renal patients pursue living donation.
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Affiliation(s)
- Amy D Waterman
- Washington University School of Medicine, St. Louis, Mo, USA
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17
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Johnson DS, Kapoian T, Taylor R, Meyer KB. Going Upstream: Coordination to Improve CKD Care. Semin Dial 2016; 29:125-34. [PMID: 26765792 DOI: 10.1111/sdi.12461] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Care coordination for patients with chronic kidney disease has been shown to be effective in improving outcomes and reducing costs. However, few patients with CKD benefit from this systematic management of their kidney disease and other medical conditions. As a result, outcomes for patients with kidney disease are not optimal, and their cost of care is increased. For those patients who transition to kidney failure treatment in the United States, the transition does not go as well as it could. The effectiveness of treatments to delay progression of kidney disease in contemporary clinical practice does not match the efficacy of these treatments in clinical trials. Conservative care for kidney disease, which should be an option for patients who are very old and very sick, is not considered often enough or seriously enough. Opportunities for early and even pre-emptive transplantation are missed, as are opportunities for home dialysis. The process of dialysis access creation is rarely optimal. The consequence is care which is not as good as it could be, and much more expensive than it should be. We describe our initial efforts to implement care coordination for chronic kidney disease in routine clinical care and attempt to project some of the benefits to patients and the cost savings.
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Affiliation(s)
| | - Toros Kapoian
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Dialysis Clinic, Inc., North Brunswick, New Jersey
| | - Robert Taylor
- Dialysis Clinic, Inc., Nashville, Tennessee.,Nephrology Associates, Nashville, Tennessee
| | - Klemens B Meyer
- Division of Nephrology, Tufts Medical Center, Boston, Massachusetts
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18
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Doyle A, Rabie RN, Mokhtari A, Cattral M, Ghanekar A, Grant D, Greig P, Levy G, Lilly L, McGilvray I, Selzner M, Selzner N, Renner EL. Recipient factors associated with having a potential living donor for liver transplantation. Liver Transpl 2015; 21:897-903. [PMID: 25891165 DOI: 10.1002/lt.24148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/06/2015] [Accepted: 04/07/2015] [Indexed: 02/07/2023]
Abstract
Because of a persistent discrepancy between the demand for liver transplantation (LT) and the supply of deceased donor organs, there is an interest in increasing living donation rates at centers trained in this method of transplantation. We examined a large socioeconomically heterogeneous cohort of patients listed for LT to identify recipient factors associated with living donation. We retrospectively reviewed 491 consecutive patients who were listed for LT at our center over a 24-month period. Demographic, medical, and socioeconomic data were extracted from electronic records and compared between those who had a potential living donor (LD) volunteer for assessment and those who did not; 245 patients (50%) had at least 1 potential LD volunteer for assessment. Multivariate logistic regression analysis identified that patients with a LD were more likely to have Child-Pugh C disease (odds ratio [OR], 2.44; P = 0.02), and less likely to be older (OR, 0.96; P = 0.002), single (OR, 0.34; P = 0.006), divorced (OR, 0.53; P = 0.03), immigrants (OR, 0.38; P = 0.049), or from the lowest income quintile (OR, 0.44; P = 0.02). In conclusion, this analysis has identified several factors associated with access to living donation. More research is warranted to define and overcome barriers to living donor liver transplantation through targeted interventions in underrepresented populations.
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Affiliation(s)
- Adam Doyle
- Liver Transplant Program/Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Rania N Rabie
- Liver Transplant Program/Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, ON, Canada.,Department of Medicine, Southlake Regional Health Centre, Newmarket, ON, Canada
| | - Arastoo Mokhtari
- Liver Transplant Program/Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Mark Cattral
- Liver Transplant Program/Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Anand Ghanekar
- Liver Transplant Program/Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - David Grant
- Liver Transplant Program/Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Paul Greig
- Liver Transplant Program/Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Gary Levy
- Liver Transplant Program/Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Leslie Lilly
- Liver Transplant Program/Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Ian McGilvray
- Liver Transplant Program/Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Markus Selzner
- Liver Transplant Program/Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Nazia Selzner
- Liver Transplant Program/Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, ON, Canada
| | - Eberhard L Renner
- Liver Transplant Program/Multi-Organ Transplant Program, University Health Network, Toronto General Hospital, Toronto, ON, Canada
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19
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Making house calls increases living donor inquiries and evaluations for blacks on the kidney transplant waiting list. Transplantation 2015; 98:979-86. [PMID: 24825528 DOI: 10.1097/tp.0000000000000165] [Citation(s) in RCA: 90] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Blacks receive live donor kidney transplant (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), and (c) the individual patient alone in the transplant center (individual counseling [IC], n=49). RESULTS At the 2-year endpoint, 15% (n=8), 8% (n=4), and 6% (n=3) of HC, GB, and IC patients, respectively, received LDKT (P=0.30). Patients in the HC group were more likely than patients in the GB and IC groups 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). Patients in the HC group also were more likely to have higher knowledge, fewer concerns, and higher willingness to talk to others about donation 6 weeks after 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.
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20
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Skelton SL, Waterman AD, Davis LA, Peipert JD, Fish AF. Applying best practices to designing patient education for patients with end-stage renal disease pursuing kidney transplant. Prog Transplant 2015; 25:77-84. [PMID: 25758805 PMCID: PMC4489708 DOI: 10.7182/pit2015415] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Despite the known benefits of kidney transplant, less than 30% of the 615 000 patients living with end-stage renal disease (ESRD) in the United States have received a transplant. More than 100 000 people are presently on the transplant waiting list. Although the shortage of kidneys for transplant remains a critical factor in explaining lower transplant rates, another important and modifiable factor is patients' lack of comprehensive education about transplant. The purpose of this article is to provide an overview of known best practices from the broader literature that can be used as an evidence base to design improved education for ESRD patients pursuing a kidney transplant. Best practices in chronic disease education generally reveal that education that is individually tailored, understandable for patients with low health literacy, and culturally competent is most beneficial. Effective education helps patients navigate the complex health care process successfully. Recommendations for how to incorporate these best practices into transplant education design are described. Providing more ESRD patients with transplant education that encompasses these best practices may improve their ability to make informed health care decisions and increase the numbers of patients interested in pursuing transplant.
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Affiliation(s)
| | - Amy D Waterman
- David Geffen School of Medicine at UCLA Los Angeles, California
| | | | - John D Peipert
- David Geffen School of Medicine at UCLA Los Angeles, California
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21
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The decline in living kidney donation in the United States: random variation or cause for concern? Transplantation 2013; 96:767-73. [PMID: 23759882 DOI: 10.1097/tp.0b013e318298fa61] [Citation(s) in RCA: 93] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The annual number of living kidney donors in the United States peaked at 6647 in 2004. The preceding decade saw a 120% increase in living kidney donation. However, since 2004, living kidney donation has declined in all but 1 year, resulting in a 13% decline in the annual number of living kidney donors from 2004 to 2011. The proportional decline in living kidney donation has been more pronounced among men, blacks, younger adults, siblings, and parents. In this article, we explore several possible explanations for the decline in living kidney donation, including an increase in medical unsuitability, an aging transplant patient population, financial disincentives, public policies, and shifting practice patterns, among others. We conclude that the decline in living donation is not merely reflective of random variation but one that warrants action by the transplant centers, the broader transplant community, and the state and national governments.
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22
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Wilson R, Brown DR, Boothe MAS, Weng FL. Improving the delivery of patient education about kidney transplant in a transplant center. Prog Transplant 2013. [PMID: 23187059 DOI: 10.7182/pit2012716] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Kidney transplant is usually the best treatment option for patients with end-stage renal disease; however, transplant rates remain low in the United States. More research is needed about patients' educational needs to ensure that patients are making informed decisions about their treatment options. OBJECTIVE To examine patients' perceptions of the delivery and format of a kidney transplant education program in a clinical setting, specifically to (1) identify useful aspects of the transplant education process, (2) discuss aspects of the program delivery that need improvement, and (3) provide recommendations to enhance the education delivery and format surrounding kidney transplant. DESIGN A descriptive study using focus group meetings with patients at different stages of the transplantation process (in evaluation, listed, and transplant recipients). Data were analyzed by using thematic content analysis. RESULTS Use of printed materials and handouts, group education format, and patient advocate component as well as bringing a companion were all effective aspects of the education program. Concerns about the education program stemmed from its complexity, technicality, and length. Participants recommended that patients be sent a formal invitation letter, with a detailed agenda and a video on kidney transplant, and that patients be encouraged to bring a companion to the education program. Responses specific to the stage of the transplant process are presented. CONCLUSION Concentrated attention to the delivery and content of the transplant education programs may significantly assist with patients' outcomes throughout the transplant process.
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Affiliation(s)
- Rula Wilson
- University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
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23
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DePasquale N, Hill-Briggs F, Darrell L, Boyér LL, Ephraim P, Boulware LE. Feasibility and acceptability of the TALK social worker intervention to improve live kidney transplantation. HEALTH & SOCIAL WORK 2012; 37:234-249. [PMID: 23301437 PMCID: PMC3954101 DOI: 10.1093/hsw/hls034] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 05/03/2012] [Accepted: 05/24/2012] [Indexed: 06/01/2023]
Abstract
Live kidney transplantation (LKT) is underused by patients with end-stage renal disease. Easily implementable and effective interventions to improve patients' early consideration of LKT are needed. The Talking About Live Kidney Donation (TALK) social worker intervention (SWI) improved consideration and pursuit of LKT among patients with progressive chronic kidney disease in a recent randomized controlled trial: Patients and their families were invited to meet twice with a social worker to discuss their self-identified barriers to seeking LKT and to identify solutions to barriers. The authors audio recorded and transcribed all social worker visits to assess implementation of the TALK SWI and its acceptability to patients and families. The study social worker adhered to the TALK SWI protocol more than 90 percent of the time. Patients and families discussed medical (for example, long-term risks of transplant), psychological (for example, patients' denial of the severity of their disease), and economic (for example, impact of donation on family finances) concerns regarding LKT. Most patients and families felt that the intervention was helpful. Consistently high adherence to the TALK SWI protocol and acceptability of the intervention among patients and families suggest that the TALK SWI can be feasibly implemented in clinical practice.
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24
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Cooper M, Kramer A, Barth R, Phelan M. Living kidney donor relationship in Caucasian and African American populations and implications for targeted donor education programs. Clin Transplant 2012; 27:32-6. [PMID: 22775242 DOI: 10.1111/j.1399-0012.2012.01685.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE The opportunities for living kidney donation vary greatly among socioeconomic and racial groups. We reviewed our series of living donors to evaluate donor relationships in various groups. MATERIALS AND METHODS Donor and recipient records for 1000 patients were reviewed. An additional 857 records of potential recipients presenting with a donor were analyzed. We compared the relationship of the recipient to initial donor and individual who underwent nephrectomy. RESULTS There were 693 CC and 263 AA live kidney donors. In the AA population donors were first-degree 71%, second-degree 10%, and unrelated 19%. In the CC population donors were first-degree 57%, second-degree 6%, and unrelated 37% (p < 0.0001 for unrelated CC vs. AA). Spousal donation is more common in CC donors (13%) than AA donors (6%), p = 0.001. Donation from child to parent is more common in AA (33%) than CC donors (15%), p < 0.0001. AA recipients predominantly identified a child as a donor in 63% and 48% were cleared for donation. In contrast, 69% of CC recipients identified a spouse as a donor yet only 23% became donors, p < 0.001 and p < 0.001. CONCLUSIONS There is a higher incidence of unrelated donors in the caucasian population, vs. first degree relatives often being living donors in the AA population.
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Affiliation(s)
- Matthew Cooper
- Division of Transplantation, University of Maryland Medical System, Baltimore, MD, USA.
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25
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Abstract
BACKGROUND Although end-stage kidney disease in African Americans (AAs) is four times greater than in whites, AAs are less than one half as likely to undergo kidney transplantation (KT). This racial disparity has been found even after controlling for clinical factors such as comorbid conditions, dialysis vintage and type, and availability of potential living donors. Therefore, studying nonmedical factors is critical to understanding disparities in KT. METHODS We conducted a longitudinal cohort study with 127 AA and white patients with end-stage kidney disease undergoing evaluation for KT (December 2006 to July 2007) to determine whether, after controlling for medical factors, differences in time to acceptance for transplant is explained by patients' cultural factors (e.g., perceived racism and discrimination, medical mistrust, religious objections to living donor KT), psychosocial characteristics (e.g., social support, anxiety, depression), or transplant knowledge. Participants completed two telephone interviews (shortly after initiation of transplant evaluation and after being accepted or found ineligible for transplant). RESULTS Results indicated that AA patients reported higher levels of the cultural factors than did whites. We found no differences in comorbidity or availability of potential living donors. AAs took significantly longer to get accepted for transplant than did whites (hazard ratio=1.49, P=0.005). After adjustment for demographic, psychosocial, and cultural factors, the association of race with longer time for listing was no longer significant. CONCLUSIONS We suggest that interventions to address racial disparities in KT incorporate key nonmedical risk factors in patients.
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Hall EC, James NT, Garonzik Wang JM, Berger JC, Montgomery RA, Dagher NN, Desai NM, Segev DL. Center-level factors and racial disparities in living donor kidney transplantation. Am J Kidney Dis 2012; 59:849-57. [PMID: 22370021 DOI: 10.1053/j.ajkd.2011.12.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2011] [Accepted: 12/19/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND On average, African Americans attain living donor kidney transplantation (LDKT) at decreased rates compared with their non-African American counterparts. However, center-level variations in this disparity or the role of center-level factors is unknown. STUDY DESIGN Observational cohort study. SETTING & PARTICIPANTS 247,707 adults registered for first-time kidney transplants from 1995-2007 as reported by the Scientific Registry of Transplant Recipients. PREDICTORS Patient-level factors (age, sex, body mass index, insurance status, education, blood type, and panel-reactive antibody level) were adjusted for in all models. The association of center-level characteristics (number of candidates, transplant volume, LDKT volume, median time to transplant, percentage of African American candidates, percentage of prelisted candidates, and percentage of LDKT) and degree of racial disparity in LDKT was quantified. OUTCOMES Hierarchical multivariate logistic regression models were used to derive center-specific estimates of LDKT attainment in African American versus non-African American candidates. RESULTS Racial parity was not seen at any of the 275 transplant centers in the United States. At centers with the least racial disparity, African Americans had 35% lower odds of receiving LDKT; at centers with the most disparity, African Americans had 76% lower odds. Higher percentages of African American candidates (interaction term, 0.86; P = 0.03) and prelisted candidates (interaction term, 0.80; P = 0.001) at a given center were associated with increased racial disparity at that center. Higher rates of LDKT (interaction term, 1.25; P < 0.001) were associated with less racial disparity. LIMITATIONS Some patient-level factors are not captured, including a given patient's pool of potential donors. Geographic disparities in deceased donor availability might affect LDKT rates. Center-level policies and practices are not captured. CONCLUSIONS Racial disparity in attainment of LDKT exists at every transplant center in the country. Centers with higher rates of LDKT attainment for all races had less disparity; these high-performing centers might provide insights into policies that might help address this disparity.
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Affiliation(s)
- Erin C Hall
- Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD 21205, USA
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Smith SW, Nazione S, LaPlante C, Clark-Hitt R, Park HS, Sung R, Leichtman A. Living kidney donor decision making and communication. JOURNAL OF HEALTH COMMUNICATION 2011; 16:870-888. [PMID: 21660829 DOI: 10.1080/10810730.2011.563668] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
There is high demand for kidney donors in the United States, and it is widely accepted that living donation is optimal for individuals who need a kidney. Much research has focused on the potential recipient, but little has been studied about the communication and decision making of living kidney donors. Interviews assessed the communication and decision-making processes of 43 kidney donor volunteers. Almost all of the participants were not asked, but instead volunteered, to donate. The majority of donors reported having conversations with the recipient and speaking about their decisions with other individuals in their social networks besides the recipient. Some participants said that they stopped talking to others because of negative feedback. Future research should further examine the communication of donors with non-recipient others and potential methods of training recipients and donors to communicate effectively about the donation process.
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Affiliation(s)
- Sandi W Smith
- Department of Communication, Michigan State University, East Lansing, Michigan 48824, USA.
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Translating knowledge on best practice into improving quality of RRT care: a systematic review of implementation strategies. Kidney Int 2011; 80:1021-34. [PMID: 21775971 DOI: 10.1038/ki.2011.222] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Recent studies showed wide variation in the extent to which guidelines and other types of best practice have been implemented as part of routine health care. This is also true for the delivery of renal replacement therapy (RRT) for ESRD patients. Increasing uptake of best practice within such complex care systems requires an understanding of implementation strategies and specific quality improvement (QI) techniques. Therefore, we systematically reviewed over 5000 titles published since 1990 and included papers describing planned attempts to accelerate uptake of best RRT practice into daily care. This resulted in a list of 93 QI initiatives, categorized in order to expedite shared learning. The majority of the initiatives were executed within the domains of vascular access, nutrition, and anemia management. Strategies oriented at patients were most common and many initiatives pre-defined an improvement target before starting implementation. Of the 93 initiatives, 22 were sufficiently robust methodologically to be analyzed in more detail. Our results tend to support previous findings that multifaceted strategies are more effective than single strategies. Improving our understanding of how to successfully implement best practice can inform system-level change and is the only way to close the gap between knowledge on what works and the actual care delivered to ESRD patients. Research into implementation, using specific QI techniques, should therefore be given priority in future.
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Information Channels and the Dynamics of Uptake of Living Kidney Donors: A Retrospective Study in a Reference Area. Transplant Proc 2011; 43:2157-9. [DOI: 10.1016/j.transproceed.2011.05.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
PURPOSE OF REVIEW High prevalence of comorbidities such as diabetes, hypertension, obesity, hepatitis B and C, in minority groups, results in racial minorities being disproportionally represented on transplant waiting lists. Organ transplantation positively impacts patient survival but greater access is limited by a severe donor shortage. RECENT FINDINGS Unfortunately, minority groups also suffer from disparities in deceased and living donation. African-Americans comprise 12.9% of the population and 34% of the kidney transplant waiting list but only 13.8% of deceased donors. Barriers to minority deceased donation include: decreased awareness of transplantation, religious or cultural distrust of the medical community, fear of medical abandonment and fear of racism. Furthermore, African-Americans comprise only 11.8% of living donors. Barriers to minority living donation include: unwillingness to donate, medical comorbid conditions, trust or fear of medical community, loss to follow-up, poor coping mechanisms, financial concerns, reluctance to ask family members and friends, fear of surgery, and lack of awareness about living donor kidney transplantation. SUMMARY Transplant center-based education classes significantly and positively impact African-American concerns and beliefs surrounding living donation. Community and national strategies utilizing culturally sensitive communication and interventions can ameliorate disparities and improve access to transplantation.
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Barnieh L, McLaughlin K, Manns BJ, Klarenbach S, Yilmaz S, Taub K, Hemmelgarn BR. Evaluation of an education intervention to increase the pursuit of living kidney donation: a randomized controlled trial. Prog Transplant 2011. [PMID: 21485941 DOI: 10.7182/prtr.21.1.e008266m25jtr77v] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONTEXT Many transplant candidates have concerns about living donation. OBJECTIVE To determine whether a structured educational session increased eligible kidney transplant candidates' pursuit of living donation. DESIGN AND INTERVENTION Eligible transplant candidates were randomized to standard of care (n = 50) or to the educational intervention (n = 50), which included both written materials and a 2-hour education session. The primary outcome was having a living donor contact the transplant program to express interest in donation for a patient, and a secondary outcome was the candidates' preference for treatment of end-stage renal disease; both outcomes were determined at 3 months after enrollment. RESULTS Of the 100 patients randomized, 4 in the intervention group and 2 in the standard of care group had a living donor contact the program (P = .45). Within-group changes in treatment preference from baseline were seen in the education intervention group (P = .02), but not in the standard of care group (P = .37). CONCLUSIONS This educational intervention did not increase the likelihood of a potential donor contacting the transplant program, compared with standard care. However, patients who received the educational intervention were more likely to change their treatment preference to living donation at study completion. Research investigating other methods of increasing living transplant rates is urgently required.
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Barnieh L, McLaughlin K, Manns BJ, Klarenbach S, Yilmaz S, Taub K, Hemmelgarn BR. Evaluation of an Education Intervention to Increase the Pursuit of Living Kidney Donation: A Randomized Controlled Trial. Prog Transplant 2011; 21:36-42. [DOI: 10.1177/152692481102100105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Context Many transplant candidates have concerns about living donation. Objective To determine whether a structured educational session increased eligible kidney transplant candidates' pursuit of living donation. Design and Intervention Eligible transplant candidates were randomized to standard of care (n = 50) or to the educational intervention (n = 50), which included both written materials and a 2-hour education session. The primary outcome was having a living donor contact the transplant program to express interest in donation for a patient, and a secondary outcome was the candidates' preference for treatment of end-stage renal disease; both outcomes were determined at 3 months after enrollment. Results Of the 100 patients randomized, 4 in the intervention group and 2 in the standard of care group had a living donor contact the program ( P = .45). Within-group changes in treatment preference from baseline were seen in the education intervention group ( P = .02), but not in the standard of care group (P = .37). Conclusions This educational intervention did not increase the likelihood of a potential donor contacting the transplant program, compared with standard care. However, patients who received the educational intervention were more likely to change their treatment preference to living donation at study completion. Research investigating other methods of increasing living transplant rates is urgently required.
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Affiliation(s)
- Lianne Barnieh
- University of Calgary, Calgary, Alberta, Canada (LB, KM, BJM, SY, KT, BRH), University of Alberta, Edmonton, Alberta, Canada (SK)
| | - Kevin McLaughlin
- University of Calgary, Calgary, Alberta, Canada (LB, KM, BJM, SY, KT, BRH), University of Alberta, Edmonton, Alberta, Canada (SK)
| | - Braden J. Manns
- University of Calgary, Calgary, Alberta, Canada (LB, KM, BJM, SY, KT, BRH), University of Alberta, Edmonton, Alberta, Canada (SK)
| | - Scott Klarenbach
- University of Calgary, Calgary, Alberta, Canada (LB, KM, BJM, SY, KT, BRH), University of Alberta, Edmonton, Alberta, Canada (SK)
| | - Serdar Yilmaz
- University of Calgary, Calgary, Alberta, Canada (LB, KM, BJM, SY, KT, BRH), University of Alberta, Edmonton, Alberta, Canada (SK)
| | - Ken Taub
- University of Calgary, Calgary, Alberta, Canada (LB, KM, BJM, SY, KT, BRH), University of Alberta, Edmonton, Alberta, Canada (SK)
| | - Brenda R. Hemmelgarn
- University of Calgary, Calgary, Alberta, Canada (LB, KM, BJM, SY, KT, BRH), University of Alberta, Edmonton, Alberta, Canada (SK)
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Weng FL, Reese PP, Mulgaonkar S, Patel AM. Barriers to living donor kidney transplantation among black or older transplant candidates. Clin J Am Soc Nephrol 2010; 5:2338-47. [PMID: 20876682 DOI: 10.2215/cjn.03040410] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND OBJECTIVES Lower rates of living donor kidney transplant (LDKT) among transplant candidates who are black or older may stem from lower likelihoods of (1) recruiting potential living donors or (2) potential donors actually donating (donor "conversion"). DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A single-center, retrospective cohort study was performed to determine race, age, and gender differences in LDKT, donor recruitment, and donor conversion. RESULTS Of 1617 kidney transplant candidates, 791 (48.9%) recruited at least one potential living donor, and 452 (28.0%) received LDKTs. Black transplant candidates, versus non-blacks, were less likely to receive LDKTs (20.5% versus 30.6%, relative risk [RR] = 0.67), recruit potential living donors (43.9% versus 50.7%, RR = 0.86), and receive LDKTs if they had potential donors (46.8% versus 60.3%, RR = 0.78). Transplant candidates ≥60 years, versus candidates 18 to <40 years old, were less likely to receive LDKTs (15.1% versus 43.2%, RR = 0.35), recruit potential living donors (34.0% versus 64.6%, RR = 0.53), and receive LDKTs if they had potential donors (44.5% versus 66.8%, RR = 0.67). LDKT and donor recruitment did not differ by gender. Race and age differences persisted in multivariable logistic regression models. Among 339 candidates who recruited potential donors but did not receive LDKTs, blacks (versus non-blacks) were more likely to have potential donors who failed to donate because of a donor-related reason (86.9% versus 72.5%). CONCLUSIONS Black or older kidney transplant candidates were less likely to receive LDKTs because of lower likelihoods of donor recruitment and donor conversion.
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Affiliation(s)
- Francis L Weng
- Renal and Pancreas Transplant Division, Saint Barnabas Health Care System, Saint Barnabas Medical Center, Livingston, NJ 07039, USA.
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Waterman AD, Robbins ML, Paiva AL, Hyland SS. Kidney patients' intention to receive a deceased donor transplant: development of stage of change, decisional balance and self-efficacy measures. J Health Psychol 2010; 15:436-45. [PMID: 20348364 DOI: 10.1177/1359105309351248] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In order to sustain life, patients whose kidneys fail must receive dialysis or obtain a transplant. This study reports on the development and validation of measures of Stage of Change, Decisional Balance and Self-efficacy based on the Transtheoretical Model (TTM) to assess patients' readiness to receive a deceased donor transplant. We surveyed 293 transplant-eligible kidney patients about their deceased donation readiness. Exploratory and confirmatory analyses for all measures demonstrated factor structures similar to previous application of the TTM to other health behaviors, excellent model fit and good internal and external validity. These brief, reliable instruments with good psychometric properties can guide the development of improved, individually-tailored transplant education for patients.
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Affiliation(s)
- Amy D Waterman
- Washington University School of Medicine, General Medical Sciences, Campus Box 8005, 660 S. Euclid Ave, St. Louis, MO 63110-1093, USA.
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Barnieh L, McLaughlin K, Manns BJ, Klarenbach S, Yilmaz S, Hemmelgarn BR. Barriers to living kidney donation identified by eligible candidates with end-stage renal disease. Nephrol Dial Transplant 2010; 26:732-8. [DOI: 10.1093/ndt/gfq388] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Reese PP, Shea JA, Bloom RD, Berns JS, Grossman R, Joffe M, Huverserian A, Feldman HI. Predictors of having a potential live donor: a prospective cohort study of kidney transplant candidates. Am J Transplant 2009; 9:2792-9. [PMID: 19845584 PMCID: PMC2864790 DOI: 10.1111/j.1600-6143.2009.02848.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The barriers to live donor transplantation are poorly understood. We performed a prospective cohort study of individuals undergoing renal transplant evaluation. Participants completed a questionnaire that assessed clinical characteristics as well as knowledge and beliefs about transplantation. A participant satisfied the primary outcome if anyone contacted the transplant center to be considered as a live donor for that participant. The final cohort comprised 203 transplant candidates, among whom 80 (39.4%) had a potential donor contact the center and 19 (9.4%) underwent live donor transplantation. In multivariable logistic regression, younger candidates (OR 1.65 per 10 fewer years, p < 0.01) and those with annual income >or=US$ 15 000 (OR 4.22, p = 0.03) were more likely to attract a potential live donor. Greater self-efficacy, a measure of the participant's belief in his or her ability to attract a donor, was a predictor of having a potential live donor contact the center (OR 2.73 per point, p < 0.01), while knowledge was not (p = 0.56). The lack of association between knowledge and having a potential donor suggests that more intensive education of transplant candidates will not increase live donor transplantation. On the other hand, self-efficacy may be an important target in designing interventions to help candidates find live donors.
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Affiliation(s)
- Peter P. Reese
- University of Pennsylvania; Renal Division; 1 Founders, 3400 Spruce Street, Philadelphia, PA, 19104
| | - Judy A. Shea
- University of Pennsylvania, Department of Medicine; Blockley 1232, 423 Guardian Drive, Philadelphia, PA 19104
| | - Roy D. Bloom
- University of Pennsylvania; Renal Division; 1 Founders, 3400 Spruce Street, Philadelphia, PA, 19104
| | - Jeffrey S. Berns
- University of Pennsylvania; Renal Division; 1 Founders, 3400 Spruce Street, Philadelphia, PA, 19104
| | - Robert Grossman
- University of Pennsylvania; Renal Division; 1 Founders, 3400 Spruce Street, Philadelphia, PA, 19104
| | - Marshall Joffe
- University of Pennsylvania, Department of Biostatistics; Blockley 602, 423 Guardian Drive, Philadelphia, PA 19104
| | - Ari Huverserian
- University of Pennsylvania, c/o Renal Division; 1 Founders, 3400 Spruce Street, Philadelphia, PA, 19104
| | - Harold I. Feldman
- University of Pennsylvania, Center for Clinical Epidemiology and Biostatistics, 922 Blockley, 423 Guardian Drive, Philadelphia, PA, 19104
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Hays R, Waterman A. Improving preemptive transplant education to increase living donation rates: reaching patients earlier in their disease adjustment process. Prog Transplant 2008. [DOI: 10.7182/prtr.18.4.w3706w0tk23r9618] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hays R, Waterman AD. Improving Preemptive Transplant Education to Increase Living Donation Rates: Reaching Patients Earlier in Their Disease Adjustment Process. Prog Transplant 2008; 18:251-6. [DOI: 10.1177/152692480801800407] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Patients who receive a preemptive kidney transplant before starting dialysis avoid the medical complications related to dialysis and have the highest graft success and lowest mortality rates. Because only 2.5% of incident patients receive kidney transplants preemptively, improved psychosocial education may assist more patients in accessing preemptive transplant. This article outlines (1) unique psychosocial issues affecting patients with chronic kidney disease stage 4 (glomerular filtration rates >20 mL/min per 1.73 m2) and (2) how an educational program about preemptive living donor transplant should be designed and administered to increase access to this treatment option. Early referral patients may be overwhelmed in coping with and learning about their disease and, therefore, not ready to make a treatment decision, or they may be highly motivated to obtain a transplant to avoid dialysis and return to a normal life. An education program that defines the quality-of-life and health benefits possible with early transplant is outlined. The program is focused on minimizing the disruption of starting 2 treatment techniques and maximizing early transplant health, graft survival, employability, and retention of insurance coverage. Once the benefits of preemptive living donor transplant are outlined, educators can focus on demystifying the living donor evaluation process and assisting interested patients in planning how to find a living donor. To reach all patients, especially racial minorities, education about preemptive transplant should be available in primary-care physicians' and community nephrologists' offices, at dialysis centers, and through other kidney organizations.
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Affiliation(s)
- Rebecca Hays
- University of Wisconsin Hospital and Clinics, Madison (RH), Washington University School of Medicine, St Louis, Missouri (ADW)
| | - Amy D. Waterman
- University of Wisconsin Hospital and Clinics, Madison (RH), Washington University School of Medicine, St Louis, Missouri (ADW)
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Pradel FG, Jain R, Mullins CD, Vassalotti JA, Bartlett ST. A survey of nephrologists' views on preemptive transplantation. Clin J Am Soc Nephrol 2008; 3:1837-45. [PMID: 18832107 DOI: 10.2215/cjn.00150108] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite emerging evidence that preemptive transplantation is the best treatment modality for patients reaching end-stage renal disease (ESRD), it is underutilized. Nephrologists' views on preemptive transplantation are explored herein. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS A web-based survey elicited barriers to preemptive transplantation as perceived by nephrologists as well as demographic and practice variables associated with a favorable attitude toward preemptive transplantation. RESULTS Four hundred seventy-six of 5,901 eligible nephrologists responded (8% participation rate). Seventy-one percent of respondents agreed that preemptive transplantation is the best treatment modality for eligible chronic kidney disease (CKD) patients reaching ESRD, 69% reported that late referrals did not allow enough time for patients to be evaluated for preemptive transplantation, and 50% stated that there was too much delay between a patient's referral and the time the patient was seen at the transplant center. Nephrologists agreed to a lesser extent that they should be held accountable for CKD patients' education (26%) and preemptive transplant referrals (23%). The most important patient factors considered when deciding not to discuss preemptive transplant were poor health status (70%), lack of compliance (69%), other medical problems (51%), being too old (40%), lack of prescription coverage (37%), and lack of health insurance to cover the costs of the procedure (36%). CONCLUSIONS Surveyed nephrologists consider preemptive transplantation as the optimal treatment modality for eligible patients. Late referral, patient health and insurance status, and delayed transplant center evaluation are perceived as major barriers to preemptive transplantation.
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Affiliation(s)
- Françoise G Pradel
- Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore,Maryland 21201, USA.
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Boulware LE, Troll MU, Plantinga LC, Powe NR. The association of state and national legislation with living kidney donation rates in the United States: a national study. Am J Transplant 2008; 8:1451-70. [PMID: 18510639 PMCID: PMC2574918 DOI: 10.1111/j.1600-6143.2008.02266.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The effect of state legislation and federal policies supporting living donors on living kidney donation rates in the United States is unknown. We studied living kidney donation rates from 1988 to 2006, and we assessed changes in donation before and after the enactment of state legislation and the launch of federal initiatives supporting donors. During the study, 27 states enacted legislation. Among states enacting legislation, there was no statistically significant difference in the average rate of increase in overall living kidney donations after compared to before state legislation enactment (annual increase in donations per 1 000 000 population [95% confidence interval] 2.39 [1.94-2.84] compared to 1.68 [0.89-2.47] respectively, p > 0.05). Among states not enacting legislation, there was a statistically significantly greater annual increase in overall donation rates from 1997 to 2002 compared to before 1997 when federal initiatives commenced, but there was no growth in annual rates after 2002. State and federal legislation were associated with increases in living-unrelated donation. These findings suggest that although existing public policies were not associated with improvements in the majority of donations from living-related donors, they may have had a selective effect on barriers to living-unrelated kidney donation.
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Affiliation(s)
- L. E. Boulware
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD,*Corresponding author: L. Ebony Boulware,
| | - M. U. Troll
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
| | - L. C. Plantinga
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
| | - N. R. Powe
- Department of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Medical Institutions, Baltimore, MD, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins Medical Institutions, Baltimore, MD, Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, MD
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Waterman A, Barrett A, Stanley S. Optimal transplant education for recipients to increase pursuit of living donation. Prog Transplant 2008. [DOI: 10.7182/prtr.18.1.d4r0564645ut6074] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Waterman AD, Barrett AC, Stanley SL. Optimal Transplant Education for Recipients to Increase Pursuit of Living Donation. Prog Transplant 2008; 18:55-62. [DOI: 10.1177/152692480801800111] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Context Inadequate transplant education may stop kidney patients from beginning or completing evaluation or limit recipients from considering living donation. Objective To learn about recipients' decision making about living donation and preferred transplant education resources. Design Retrospective, cross-sectional survey. Patients—304 kidney recipients. Main Outcome Measures Living donation comfort, concerns, education preferences. Results Recipients spent 10 median hours learning about transplant, primarily by speaking to medical staff (2–3 hours) and reading transplant brochures (0–1 hour). Twelve percent had not received any education before coming to the transplant center. At least 75% wanted education discussing the evaluation, surgery, and medical tests required of recipients and donors, as well as common transplant-related fears. Recipients who received living donor transplants were more interested in information about donors' evaluation ( P< .001), surgery ( P< .001), medical tests ( P< .001), and donation concerns ( P= .004) than were other recipients. Recipients who had living donors evaluated were more comfortable accepting family members or friends who volunteered rather than asking potential donors because of concerns about pressuring donors (85%), harming their health (83%), or causing them pain or inconvenience (76%). Besides providing accurate medical information, education that addresses recipients' fears about transplantation, explains living donors' donation experiences, and teaches patients how to pursue living donation may increase recipients' pursuit of living donation.
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Affiliation(s)
- Amy D. Waterman
- Washington University School of Medicine, St Louis, Missouri
| | - Ann C. Barrett
- Washington University School of Medicine, St Louis, Missouri
| | - Sara L. Stanley
- Washington University School of Medicine, St Louis, Missouri
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Pradel FG, Bartlett ST. Does a home-based education program improve rates of living donor kidney transplantation? NATURE CLINICAL PRACTICE. NEPHROLOGY 2007; 3:366-7. [PMID: 17489090 DOI: 10.1038/ncpneph0499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2007] [Accepted: 04/03/2007] [Indexed: 05/15/2023]
Affiliation(s)
- Françoise G Pradel
- University of Maryland, School of Pharmacy, Baltimore, MD 21201-1563, USA.
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Myaskovsky L, Switzer GE, Crowley-Matoka M, Unruh M, DiMartini AF, Dew MA. Psychosocial factors associated with ethnic differences in transplantation. Curr Opin Organ Transplant 2007. [DOI: 10.1097/mot.0b013e32805b7192] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rodrigue JR, Cornell DL, Lin JK, Kaplan B, Howard RJ. Increasing live donor kidney transplantation: a randomized controlled trial of a home-based educational intervention. Am J Transplant 2007; 7:394-401. [PMID: 17173659 DOI: 10.1111/j.1600-6143.2006.01623.x] [Citation(s) in RCA: 161] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
With the shortage of deceased donor kidneys and the superior clinical outcomes possible with live donor kidney transplantation (LDKT), more patients should seriously consider LDKT. However, little is known about how best to educate patients and their family members about LDKT. We evaluated the effectiveness of a home-based (HB) educational program in increasing LDKT. Patients were randomized to clinic-based (CB) education alone (CB, n = 69) or CB plus HB education (CB+HB, n = 63). Compared to CB, more patients in the CB+HB group had living donor inquiries (63.8% vs. 82.5%, p = 0.019) and evaluations (34.8% vs. 60.3%, p = 0.005) and LDKTs (30.4% vs. 52.4%, p = 0.013). Assignment to the CB+HB group, White race, more LDKT knowledge, higher willingness to discuss LDKT with others, and fewer LDKT concerns were predictors of having LDKT (p-values < 0.05). Both groups demonstrated an increase in LDKT knowledge after the CB education, but CB+HB led to an additional increase in LDKT knowledge (p < 0.0001) and in willingness to discuss LDKT with others (p < 0.0001), and a decrease in LDKT concerns (p < 0.0001). Results indicate that an HB outreach program is more effective in increasing LDKT rates than CB education alone.
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Affiliation(s)
- J R Rodrigue
- The Transplant Center and the Department of Psychiatry, Beth Israel Deaconess Medical Center, 110 Francis Street, LMOB-7th Floor, Boston, Massachusetts, USA.
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Waterman A, Stanley S, Covelli T, Hazel E, Hong B, Brennan D. Living donation decision making: recipients' concerns and educational needs. Prog Transplant 2006. [DOI: 10.7182/prtr.16.1.h8t81214751905lu] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Verna EC, Hunt KH, Renz JF, Rudow DL, Hafliger S, Dove LM, Kinkhabwala M, Emond JC, Brown RS. Predictors of candidate maturation among potential living donors. Am J Transplant 2005; 5:2549-54. [PMID: 16162206 DOI: 10.1111/j.1600-6143.2005.01066.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The shortage of deceased donor allografts and improved outcomes in partial organ transplantation have led to widespread application of adult-to-adult living donor liver transplantation. Donor selection limits overall utilization of this technique and predictors of candidate maturation have been inadequately studied to date. We therefore collected data on 237 consecutive potential donors including their age, sex, ethnicity, relationship to the recipient, education, employment and religious beliefs and practices. Of these 237 candidates, 91 (38%) were excluded for medical and psychosocial reasons, 53 (22%) withdrew from the process predonation and 93 (39%) underwent partial liver donation. In multivariate analyses, the relationship between the donor and the recipient was highly predictive of successful donation. For pediatric recipients, no parents voluntarily withdrew from the evaluation process. For adult recipients, spouses are the most likely to donate, followed by parents, children and siblings. Additional predictors for donation included self-description as religious but not regularly practicing, part-time employment and higher education. Race, ethnicity, gender and age did not predict donation in multivariate analysis. Further understanding of the complex decision to donate may improve donation rates as well as permit more efficient and cost-effective donor evaluation strategies.
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Affiliation(s)
- Elizabeth C Verna
- Center for Liver Disease and Transplantation, New York Presbyterian Hospital, New York, NY, USA
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Young CJ, Kew C. Health disparities in transplantation: focus on the complexity and challenge of renal transplantation in African Americans. Med Clin North Am 2005; 89:1003-31, ix. [PMID: 16129109 DOI: 10.1016/j.mcna.2005.05.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The field of renal transplantation has grown exponentially as a result of a greater understanding of the immune system and the advent of numerous immunosuppressive agents. Although African Americans and whites have benefited from these advances, equivalent long-term success eludes African Americans who are disadvantaged in gaining access to renal transplantation. This review summarizes the obstacles for African Americans to end-stage renal disease(ESRD) care, focusing on transplantation. Factors that predispose African Americans for ESRD, impede this ethnic group from timely transplantation, and negatively influence graft survival are examined. Possible solutions to these persistent problems are offered.
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Affiliation(s)
- Carlton J Young
- Division of Transplantation, Department of Surgery, University of Alabama at Birmingham, Lyons-Harrison Research Building, LHRB 728, Birmingham, AL 35294-0007, USA.
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Stothers L, Gourlay WA, Liu L. Attitudes and predictive factors for live kidney donation: a comparison of live kidney donors versus nondonors. Kidney Int 2005; 67:1105-11. [PMID: 15698451 DOI: 10.1111/j.1523-1755.2005.00176.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Live donor kidney transplantation (LDKT), although far from risk free, is a reasonably safe procedure for medically suitable donors. We hypothesized that both potential recipients and donors have identifiable and modifiable factors that contribute to the likelihood of LDKT. The objectives of this study were to describe and quantify these factors using anonymous, confidential questionnaires. METHODS Specifically designed questionnaires addressing personal characteristics, knowledge, and beliefs about LDKT were mailed to 127 previous donors and 387 relatives of patients newly listed on the cadaver transplant wait-list. Ninety-eight (77%) and 243 (63%) responses were returned by donors and nondonors, respectively. RESULTS There were significant differences between groups in gender, ethnicity, hours worked per week, and annual income. Significant differences were seen in both knowledge and beliefs about LDKT. Most donors indicated they made their decisions without lengthy deliberation or research about kidney donation. Only 20% of nondonors feel they are well informed about LDKT. CONCLUSION It is likely possible to improve knowledge about LDKT among friends and relations of patients with renal failure, but it is not certain that this will lead to increased donation because most donors don't appear to deliberate or research organ donation before making a commitment to donate. Strategies to educate potential donors should initially focus on the recipient.
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Affiliation(s)
- Lynn Stothers
- Department of Surgery and Division of Urology, University of British Columbia, The Bladder Care Centre, Vancouver, British Columbia, Canada.
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