Despite efforts to increase access to cadaveric renal transplant for women and ethnic minorities, studies of ESRD patients show lower rates of access to the waiting list among these groups. We explored listing among transplant-eligible African American and white men and women, to identify social causes of these nationally observed differences. We collected data from patients, care providers, and medical record review in 3 Baltimore-area not-for-profit hemodialysis units, reviewing records on all patients (n=297), and interviewing transplant-eligible African American and white patients age 21 to 70 (n=114), and unit staff(n=37). Among transplant-eligible patients, significant variation in listing and desire for transplant were observed. Women and older patients were less likely to be listed for cadaveric transplant, as well as patients with prior experiences of racial discrimination, and acceptance of discrimination as a fact of life. Among unlisted patients, those wanting transplantation were younger, and were less likely to have experienced discrimination. Overall, attitudes and experiences predicted list access more strongly than race. General satisfaction with care was high among patients, and non-medical care discrimination was more important in predicting list status. The impact of lifetime experiences of discrimination on patient status is significant, and may explain some of the racial and gender differences in access to care. Patients who accept disadvantage without actively challenging it may be especially likely to remain unlisted. To reduce disadvantage in transplant listing, providers and policy makers must understand the link between such experiences and current patient choices, and address these patients' needs in a culturally sensitive manner.
Learning Objectives: Understand the perspectives of African American and white hemodialysis patients about kidney transplant. Examine the role of discrimination experiences in patients' medical care decision making. Speculate on possible links between discrimination experiences and racial and gender differences in access to renal transplant
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
The 128th Annual Meeting of APHA