Live donor kidney transplantation (LDKT) represents an optimal therapy for many patients. However, African Americans have been persistently and significantly less likely to receive LDKT when compared to Whites. The process of seeking and establishing a live donor for LDKT requires potential donors overcome several potential obstacles to LKDT. As a critical first step to seeking LDKT, patients must engage their physicians and their family members or friends (who provide support for patients'health decisions and could also be potential donors) in discussions about LDKT to determine whether LDKT is a viable and/or desirable treatment option. LDKT discussions with physicians help patients and family members understand the risks and benefits of LDKT to both the potential recipient and any potential donors. Families'LDKT discussions help them establish whether it is possible to identify willing and medically eligible live donors, and they help families discuss the potential psychological, physical, and financial strains of LDKT on patients and families. Once discussions have occurred, potential donors must confront logistical (e.g., childcare or travel to transplant centers) and financial (e.g., unpaid time away from work) challenges associated with LDKT. Studies have shown that even when African American patients desire LDKT, rates of LDKT discussions are suboptimal. Further, African American potential live kidney donors are less likely than their White counterparts to complete the donor evaluation process, and they may be more sensitive than Whites to logistical and financial barriers to LDKT. Innovative strategies to overcome interpersonal, logistical and financial barriers to LDKT are sorely needed for African Americans, particularly those who may be highly motivated to seek this therapy. Transplant social workers routinely perform psychosocial evaluations on potential LDKT recipients and donors and are well suited to support families'navigation of LDKT discussions. Transplant social workers are also well versed in the financial aspects of LDKT (e.g., insurance coverage rules) and frequently provide financial guidance to potential LDKT recipients and donors. We propose to study innovative transplant social worker led interventions that will help African American potential LDKT recipients and their families overcome interpersonal, logistical and financial barriers to LDKT. We will randomly assign African Americans on the deceased kidney donor waiting list to receive their usual care on the transplant list or to one of two socia worker led interventions-one which helps patients and families discuss LDKT with each other and with patients'physicians, and one which provides families with financial support to overcome logistical and financial barriers to LDKT. As a primary outcome, we will measure whether the interventions activate live kidney donation on African American potential recipients'behalves. The proposed study leverages our multidisciplinary team's substantial prior experience studying culturally sensitive interventions to overcome barriers to LDKT among African Americans.
African Americans are four to six times more likely than Whites to develop kidney failure but are less likely than Whites to receive lifesaving transplants. This proposal will study two novel social worker led interventions (one behavioral, one financial) to improve live kidney donation for African Americans in need of a kidney transplant.
|Crews, Deidra C; Liu, Yang; Boulware, L Ebony (2014) Disparities in the burden, outcomes, and care of chronic kidney disease. Curr Opin Nephrol Hypertens 23:298-305|