Sociological contributions to race and health: Diversifying the ontological and methodological agenda

Access to Transplant for African American and Latino Patients Under the 2014 US Kidney Allocation System

BACKGROUND

Kidney transplant offers better outcomes and reduced costs compared with chronic dialysis. However, racial and ethnic disparities in access to kidney transplant persist despite efforts to expand access to transplant and improve the equity of deceased donor allocation. Our objective was to evaluate after listing the association of race and ethnicity with access to deceased donor kidney transplant (DDKT) after changes to the allocation system in 2014.

METHODS

This retrospective study evaluated access to DDKT after listing since the implementation of the 2014 kidney allocation system. Waitlist status and transplant outcomes were ascertained from data from the Scientific Registry of Transplant Recipients. Our analysis included every adult kidney transplant candidate on the waiting list in the US from January 1, 2015, through June 30, 2023.

RESULTS

A total of 290 763 candidates were on the waiting list for DDKT during the study period. Of these, 36.4% of candidates were African American and 22.2% were Latino. Compared with White non-Latino patients, access to DDKT after listing was reduced for African American (unadjusted hazard ratio [HR], 0.93; 95% confidence interval [CI], 0.92-0.94) and Latino individuals (unadjusted HR, 0.88; 95% CI, 0.87-0.90). After controlling for demographic and clinical factors, these differences in access to transplant widened substantially for African American (HR, 0.78; 95% CI, 0.77-0.80) and Latino patients (HR, 0.73; 95% CI, 0.72-0.74).

CONCLUSIONS

African American and Latino patients had reduced access to DDKT after listing. More effective approaches to improving access for African American and Latino individuals after listing are needed.

Death Positivity in America: The Movement-Its History and Literature

Western society is in an era of death awareness, its most recent salience: A Positive Death Movement. This article traces the evolution of American death culture by describing key periods of change, starting with the 1700s and going through the 21st century, and overviews contemporary movement scholarship. Experts suggest our current epoch is one in which a diffuse collection of individuals and organizations advocate for approaching death differently. Movement proponents aim to modify society's "conventional" death framework, which is characterized as medicalized, institutionalized, impersonal, and lacking psychosocial emotional preparation and engagement.

Biathanatos revisited: Anabaptist perspectives on voluntarily stopping eating and drinking in the face of terminal illness

Introduction

Voluntarily Stopping Eating and Drinking (VSED) is a legal means of hastening death through refusal of food and fluids – a topic rarely addressed in Christian Protestantism. Among this group, U.S. Mainline Protestants comprise nearly 15% of the population and are more likely to include social moderates and liberals who emphasize quality of life (over mere life) and may therefore be open to the practice.

Objectives

Leveraging the well-established and validated Theory of Planned Behavior – that posits a person’s intentions to carry out an action are motivated by one’s attitude, perception of subjective norms, and perceived behavioral control – this research elucidates clergy and congregants’ normative beliefs and anticipated tactical support for VSED, including their reactions to Christian-based justifications for this end-of-life option. Such reasoning includes that VSED is a “fast into eternal life” and is based on the example of Jesus Christ, who, in the face of ongoing suffering, determined the end of his own life when he stated, “It is finished,” and gave up his spirit – an insight originally argued by John Donne in Biathanatos (1647/1982).

Methods

This case study of one southern Anabaptist congregation employs a focus group and one-on-one interviews, capturing reactions to a vignette in which a hypothetical fellow parishioner intends to VSED in the face of ongoing suffering from a terminal illness.

Results

In response to the presented vignette, study participants reported their affirmation of VSED. Responses to faith-based justifications for the practice varied widely.

Conclusion

Individuals aiming to VSED in the face of terminal illness may have their intention affirmed by a church community, but will likely require additional caregiving support to achieve a hastened death. A nascent framework for future comparative studies of faith communities’ assessments of VSED is also proposed.