Racial disparities continue to exist in kidney transplantation despite the financial assurances provided by Medicare funding. African Americans make up more than 80% of the waiting list in South Carolina and receive half the cadaver kidneys procured. A major reason for this discrepancy is the poor organ donation rate in the African American community. Although living-donor transplantation offers the best therapeutic option for African American patients with end stage renal disease, only 13% of the transplanted kidneys in African Americans are from live donors. There are several recognized barriers to organ donation in the black community in the context of cadaver donation, but there is a paucity of information about live organ donation. Our overall hypothesis is that specific barriers to live organ donation in African American kidney transplant recipients and their families can be identified and overcome by an active intervention program and will lead to significantly improved live organ donation rates. A survey will first be conducted to identify specific barriers to live donor transplants in the African American community. Secondly, African American patients with end stage renal disease who are being evaluated for a kidney transplant will be randomized into a control or intervention group. African American patients and families in the control group will receive standard education provided by a non-minority member of the transplant team at the time of recipient evaluation. African American families randomized to the active intervention group (AIG) will receive the standard education from a minority nurse coordinator. An educator will ensure that content of information is uniform and is conveyed in a culturally sensitive manner. The AIG African American recipient and the family spokesperson will have additional educational sessions with the minority coordinator. Previous kidney recipient and donor African American families from the local community will meet with the recipients and families of the intervention group (AIG). Local volunteers from Area Health Education Consortium, National Kidney Foundation, Minority Pee Dee Health and Gift of Life Foundation will provide community support encouraging live organ donation. In addition to the educational interventions, AIG families identified as having significant financial hardships will be offered assistance such as travel vouchers and hotel coupons, child care support and possibly a one time reimbursement for loss of pay. It is expected that breaking down the barriers to live organ donation in the active intervention group will significantly increase donation rates. This will result in more number of African Americans receiving kidney transplants and improved graft and patient survival.
