Compared with chronic dialysis treatment, kidney transplantation generally offers a longer life span, a betterquality of life, and lower health care costs for the over 500,000 Americans with End Stage Renal Disease.Despite Medicare funding of virtually all kidney transplants, minority, female, and poor patients with EndStage Renal Disease have decreased access to kidney transplantation. In prior work, we identified the stepsin the transplant process that are responsible for creating these disparities. These include medicalsuitability, interest in receiving a transplant, referral to a transplant center for a pre-transplant workup,placement on a waiting list or identification of a living donor, and receipt of a kidney from a deceased or livingdonor. We now propose to train transplant recipients to act as transplant navigators and then test the valueof using transplant navigators to help patients and providers complete these steps.The proposed community-based randomized controlled trial will involve 100 adult hemodialysis patients at 3intervention dialysis facilities and 100 patients at 3 control facilities to compare a transplant navigatorintervention with usual care over a 24 month interval. Baseline evaluation will include sociodemographic andmedical characteristics, specific steps completed in the transplant process, and barriers to moving forward inthe transplant process. At periodic intervals, the navigator will provide tailored information and assistance topatients and their nephrologists to help them complete the tasks required at each step. The major outcomewill be completion of additional steps in the transplant process. Secondary analyses will examineimpediments to successful intervention among subjects who fail to move forward in the transplant processdespite assistance from a navigator.The proposed project will test a novel intervention that targets patients and nephrologists as they togethermake transplant-related decisions. Future work will involve determining the impact of navigators ondisparities in transplant rates, examining the cost-effectiveness of transplant navigators, and disseminatingthe intervention for use across the country. Helping patients complete steps in the transplant process maylead not only to improved access to kidney transplantation but also to better patient survival, decreasedhealth care costs, and increased quality of life.
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