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Mathur AK, Goodrich N, Hong B, Smith AR, Mandell RJ, Warren PH, Gifford KA, Ojo AO, Merion RM. Use of Federal Reimbursement for Living Donor Costs by Racial and Ethnic Minorities: Implications for Disparities in Access to Living Donor Transplantation. Transplantation 2024:00007890-990000000-00758. [PMID: 38771064 DOI: 10.1097/tp.0000000000005013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
BACKGROUND Minority race, ethnicity, and financial barriers are associated with lower rates of living donor (LD) kidney transplantation (LDKT). Financial reimbursement for LD costs may impact social determinants of health and, therefore, impact disparities in access to LDKT. METHODS Among US LDKTs, we studied associations between racial and ethnic minority status and utilization of the National Living Donor Assistance Center (NLDAC), a means-tested reimbursement program for nonmedical LD costs. We analyzed demographic, clinical, income, and survey data from NLDAC and the Scientific Registry of Transplant Recipients (January 1, 2011, to December 31, 2022) to identify predictors of NLDAC utilization. RESULTS Among 70 069 US LDKTs, 6093 NLDAC applicants were identified (9% of US LDKTs). Racial and ethnic minorities were over-represented in NLDAC-supported LDKTs compared with non-NLDAC US LDKTs (Black donors 12% versus 9%; Black recipients 15% versus 12%; Hispanic donors 21% versus 14%; Hispanic recipients 23% versus 15%; all P < 0.001). Among preemptive transplants, use of NLDAC by donors to Hispanic recipients (11%) was nearly twice as high as that of non-Hispanic recipients (6%) (P < 0.001). At time of NLDAC application, 72% stated NLDAC "will make it possible" to donate; higher proportions of minority applicants agreed (Black 80%, White 70%, P < 0.001; Hispanic 79%, non-Hispanic 70%, P < 0.001). Racial and ethnic minority-concordant transplants were significantly more likely to use NLDAC (donor/recipient: Black/Black risk-adjusted odds ratio [OR], 1.85, other/other OR 2.59, Hispanic/Hispanic OR 1.53; all P < 0.05). CONCLUSIONS Reduction of LD financial barriers may increase access to LDKT, particularly in racial and ethnic minority communities.
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Affiliation(s)
- Amit K Mathur
- Division of Transplant Surgery, Mayo Clinic in Arizona, Phoenix, AZ
| | | | - Barry Hong
- Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Abigail R Smith
- Arbor Research Collaborative for Health, Ann Arbor, MI
- Division of Biostatistics, Department of Preventative Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Kaplow K, Ruck JM, Levan ML, Thomas AG, Stewart D, Massie AB, Sung HC, Pisano SF, Sidoti C, Segev DL, Sinacore J, Waterman AD. National Attitudes Toward Living Kidney Donation in the United States: Results of a Public Opinion Survey. Kidney Med 2024; 6:100788. [PMID: 38435064 PMCID: PMC10906424 DOI: 10.1016/j.xkme.2023.100788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Rationale & Objective Understanding national attitudes about living kidney donation will enable us to identify and address existing disincentives to living kidney donation. We performed a national survey to describe living kidney donation perceptions, perceived factors that affect the willingness to donate, and analyzed differences by demographic subgroups. Study Design The survey items captured living kidney donation awareness, living kidney donation knowledge, willingness to donate, and barriers and facilitators to living kidney donation. Setting & Population We surveyed 802 US adults (aged 25-65 years) in June 2021, randomly selected from an online platform with diverse representation. Analytical Approach We developed summed, scaled indices to assess the association between the living kidney donation knowledge (9 items) and the willingness to donate (8 items) to self-reported demographic characteristics and other variables of interest using analysis of variance. All other associations for categorical questions were calculated using Pearson's χ2 and Fisher exact tests. We inductively evaluated free-text responses to identify additional barriers and facilitators to living kidney donation. Results Most (86.6%) of the respondents reported that they might or would definitely consider donating a kidney while they were still living. Barriers to living kidney donation included concerns about the risk of the surgery, paying for medical expenses, and potential health effects. Facilitators to living kidney donation included having information on the donation surgery's safety, knowing that the donor would not have to pay for medical expenses related to the donation, and hearing living kidney donation success stories. Awareness of the ability to participate in kidney-paired donation was associated with a higher willingness to donate. Limitations Potential for selection bias resulting from the use of survey panels and varied incentive amounts, and measurement error related to respondents' attention level. Conclusions Most people would consider becoming a living kidney donor. Increased rates of living kidney donation may be possible with investment in culturally competent educational interventions that address risks associated with donating, policies that reduce financial disincentives, and communication campaigns that raise awareness of kidney-paired donation and living kidney donation.
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Affiliation(s)
- Katya Kaplow
- Department of Surgery, New York University Langone, New York, New York
| | - Jessica M. Ruck
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Macey L. Levan
- Department of Surgery, New York University Langone, New York, New York
| | - Alvin G. Thomas
- Department of Surgery, New York University Langone, New York, New York
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Darren Stewart
- Department of Surgery, New York University Langone, New York, New York
| | - Allan B. Massie
- Department of Surgery, New York University Langone, New York, New York
| | - Hannah C. Sung
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sarah F. Pisano
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Carolyn Sidoti
- Department of Surgery, New York University Langone, New York, New York
| | - Dorry L. Segev
- Department of Surgery, New York University Langone, New York, New York
| | | | - Amy D. Waterman
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
- Department of Surgery, J.C. Walter Jr Transplant Center, Houston Methodist Hospital, Houston, Texas
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Zhang C, Mathur AK. Breaking Barriers and Bridging Gaps: Advancing Diversity, Equity, and Inclusion in Kidney Transplant Care for Black and Hispanic Patients in the United States. Transpl Int 2023; 36:11455. [PMID: 37829616 PMCID: PMC10565005 DOI: 10.3389/ti.2023.11455] [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: 04/07/2023] [Accepted: 09/15/2023] [Indexed: 10/14/2023]
Abstract
Kidney transplantation offers better mortality and quality of life outcomes to patients with end-stage renal failure compared to dialysis. Specifically, living donor kidney transplantation is the best treatment for end-stage renal disease, since it offers the greatest survival benefit compared to deceased donor kidney transplant or dialysis. However, not all patients from all racial/ethnic backgrounds enjoy these benefits. While black and Hispanic patients bear the predominant disease burden within the United States, they represent less than half of all kidney transplants in the country. Other factors such as cultural barriers that proliferate myths about transplant, financial costs that impede altruistic donation, and even biological predispositions create a complex maze and can also perpetuate care inaccessibility. Therefore, blanket efforts to increase the overall donation pool may not extend access to vulnerable populations, who may require more targeted attention and interventions. This review uses US kidney transplantation data to substantiate accessibility differences amongst racial minorities as well as provides examples of successful institutional and national systemic level changes that have improved transplantation outcomes for all.
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Affiliation(s)
- Chi Zhang
- Mayo Clinic Arizona, Phoenix, AZ, United States
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
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Husain SA, Lentine KL. Policy Strategies to Reduce Financial Risks for Living Donors. KIDNEY360 2023; 4:987-989. [PMID: 37211639 PMCID: PMC10371270 DOI: 10.34067/kid.0000000000000157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/23/2023]
Affiliation(s)
- Syed Ali Husain
- Division of Nephrology, Department of Medicine, Columbia University Medical Center, New York, New York
| | - Krista L. Lentine
- Saint Louis University Transplant Center, SSM-Saint Louis University Hospital, St. Louis, Missouri
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Zhang C, Kodali L, Mour G, Jadlowiec C, Mathur AK. The impact of COVID-19 on kidney transplant care. Front Med (Lausanne) 2023; 9:1093126. [PMID: 36698806 PMCID: PMC9868174 DOI: 10.3389/fmed.2022.1093126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
The SARS-CoV-2 virus precipitated the coronavirus 2019 (COVID-19) pandemic, which placed considerable strain on healthcare systems and necessitated immediate and rapid alterations in the delivery of healthcare. In the transplant population, COVID-19 directly impacts an inherently vulnerable population in the setting of immunosuppression and co-morbidities, but also further complicates the clinical evaluation and management of kidney transplant candidates and recipients in a strained healthcare environment being challenged by the pandemic. Many transplant centers around the world saw mortality rate spikes in organ recipients related to COVID-19, and changes in care delivery abound. This review evaluates the care of the kidney transplant patient through all phases of the process including pre-operative evaluations, perioperative care, post-transplantation considerations, and how the global pandemic has changed the way we care for our patients.
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Affiliation(s)
- Chi Zhang
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ, United States,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester, Rochester, MN, United States
| | - Lavanya Kodali
- Division of Nephrology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Girish Mour
- Division of Nephrology, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Caroline Jadlowiec
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ, United States
| | - Amit K. Mathur
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ, United States,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Rochester, Rochester, MN, United States,*Correspondence: Amit K. Mathur,
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Urinary vitronectin identifies patients with high levels of fibrosis in kidney grafts. J Nephrol 2020; 34:861-874. [PMID: 33275196 PMCID: PMC8192319 DOI: 10.1007/s40620-020-00886-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/08/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND In kidney transplantation, fibrosis represents the final and irreversible consequence of the pathogenic mechanisms that lead to graft failure, and in the late stages it irremediably precedes the loss of renal function. The invasiveness of kidney biopsy prevents this condition from being frequently monitored, while clinical data are rather unspecific. The objective of this study was to find noninvasive biomarkers of kidney rejection. METHODS We carried out proteomic analysis of the urinary Extracellular Vesicles (uEVs) from a cohort of kidney transplant recipients (n = 23) classified according to their biopsy-based diagnosis and clinical parameters as interstitial fibrosis and tubular atrophy (IFTA), acute cellular rejection (ACR), calcineurin inhibitors toxicity (CNIT) and normal kidney function (NKF). RESULTS Shotgun mass spectrometry of uEV-proteins identified differential expression of several proteins among these different groups. Up to 23 of these proteins were re-evaluated using targeted proteomics in a new independent cohort of patients (n = 41) classified in the same diagnostic groups. Among other results, we found a differential expression of vitronectin (VTN) in patients displaying chronic interstitial and tubular lesions (ci and ct mean > 2 according to Banff criteria). These results were further confirmed by a pilot study using enzyme-linked immunosorbent assay (ELISA). CONCLUSION Urinary vitronectin levels are a potential stand-alone biomarker to monitor fibrotic changes in kidney transplant recipients in a non-invasive fashion.
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Mathur AK, Hong BA, Goodrich NP, Xing J, Warren PH, Gifford KA, Merion RM, Ojo AO. Satisfaction with life and depressive symptoms in living organ donors and non‐donors: New insights from the National Living Donor Assistance Center. Clin Transplant 2020; 34:e13838. [DOI: 10.1111/ctr.13838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 02/06/2020] [Accepted: 02/16/2020] [Indexed: 01/07/2023]
Affiliation(s)
- Amit K. Mathur
- Transplant Surgery Mayo Clinic Phoenix AZ USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery Mayo Clinic Phoenix Phoenix AZ USA
| | - Barry A. Hong
- Psychiatric Washington University School of Medicine St. Louis MO USA
| | | | - Jiawei Xing
- Arbor Research Collaborative for Health Ann Arbor MI USA
| | | | | | | | - Akinlolu O. Ojo
- Medical School Administration, University of Kansas School of Medicine Kansas KS USA
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Mathur AK, Stewart Lewis ZA, Warren PH, Walters MC, Gifford KA, Xing J, Goodrich NP, Bennett R, Brownson A, Ellefson J, Felan G, Gray B, Hays RE, Klein-Glover C, Lagreco S, Metzler N, Provencher K, Walz E, Warmke K, Merion RM, Ojo AO. Best practices to optimize utilization of the National Living Donor Assistance Center for the financial assistance of living organ donors. Am J Transplant 2020; 20:25-33. [PMID: 31680449 DOI: 10.1111/ajt.15684] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 10/04/2019] [Accepted: 10/24/2019] [Indexed: 01/25/2023]
Abstract
Living organ donors face direct costs when donating an organ, including transportation, lodging, meals, and lost wages. For those most in need, the National Living Donor Assistance Center (NLDAC) provides reimbursement to defray travel and subsistence costs associated with living donor evaluation, surgery, and follow-up. While this program currently supports 9% of all US living donors, there is tremendous variability in its utilization across US transplant centers, which may limit patient access to living donor transplantation. Based on feedback from the transplant community, NLDAC convened a Best Practices Workshop on August 2, 2018, in Arlington, VA, to identify strategies to optimize transplant program utilization of this valuable resource. Attendees included team members from transplant centers that are high NLDAC users; the NLDAC program team; and Advisory Group members. After a robust review of NLDAC data and engagement in group discussions, the workgroup identified concrete best practices for administrative and transplant center leadership involvement; for individuals filing NLDAC applications at transplant centers; and to improve patient education about potential financial barriers to living organ donation. Multiple opportunities were identified for intervention to increase transplant programs' NLDAC utilization and reduce financial burdens inhibiting expansion of living donor transplantation in the United States.
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Affiliation(s)
| | - Zoe A Stewart Lewis
- Transplant Surgery, New York University Langone Medical Center, New York, New York
| | | | | | | | - Jiawei Xing
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | | | - Ada Brownson
- Augusta University Transplant Program, Augusta, Georgia
| | - Jill Ellefson
- University of Wisconsin Hospital and Clinic, Madison, Wisconsin
| | - Gerardo Felan
- University of Texas Health Science Center, San Antonio, Texas
| | | | - Rebecca E Hays
- University of Wisconsin Hospital and Clinic, Madison, Wisconsin
| | | | | | | | | | - Emily Walz
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Kara Warmke
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert M Merion
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
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