Recorded presentation

Jennie P. Perryman, PhD, RN, Emory Transplant Center, Emory University, 1364 Clifton Road, NE, Box 7, Atlanta, GA 30322, 404-712-4993, jennie_perryman@emoryhealthcare.org and Nancy J. Thompson, MPH, PhD, Rollins School of Public Health of Emory University, 1518 Clifton Road, NE, Atlanta, GA 30322.

The issue of racial and ethnic disparities in transplantation is well documented with factors contributing to care disparities identified at multiple levels including: the care delivery system, the physician, and patient. The transplantation process is complex, beginning with a physician’s referral of an interested patient to a transplant center, followed by a comprehensive pre-transplant evaluation which must be completed and the patient deemed a suitable candidate; then, placement on the transplant waiting list; culminating in a wait averaging over two years to receive a transplant, unless living donor transplant (LDT) is an option. The strongest modifiable risk factor for renal transplant outcomes has been identified as waiting time on dialysis, a compelling argument for early referral (Meier-Kriesche, 2002). Factors cited by nephrologists as to why African Americans (AA’s) are less likely than whites to be referred and evaluated for renal transplantation include: patient preferences (66%), availability of living donors (66%), failure to complete an evaluation (53%), and co-morbid illnesses (52%) (Ayanian, 2004). However, in an earlier study of patients, there were no significant differences between AA and white patients relative to preferences for renal transplantation (Ayanian, 1999). Additionally, similar proportions of AA and whites believed they had a family member willing to be a living donor (Ayanian, 2004). While studies of the transplant system have been conducted revealing geographic differences in access to transplantation relative to deceased donor transplantation (Elison, 2003) and increased waiting times for deceased kidney donor transplants by AA’s (Kallich, 1993), there are no studies relative to living donation by geography and race. The current study is a thorough analysis of listing, donation (deceased and living), and transplantation (deceased and living) rates of AA’s from 1988-2003, using data from the US census, Centers for Disease Control and Prevention, the US Renal Data System, and the United Network for Organ Sharing (UNOS). The purpose of this presentation is to identify at a care delivery system level, regional differences and trends in the rates of study. Focusing on one state’s comparative results within its own region, the investigators will share a preliminary framework for a collaborative, focused, multi-level interventional approach to improving access to transplantation by AA’s, specifically LDT's, beginning with increased referrals for transplant evaluation.

Learning Objectives:

• Describe the differences in living donation and transplantation rates of African Americans.
• Identify factors attibuted to differences in transplantation and donation rates.
• Identify interventional strategies at the transplant center, dialysis clinic/nephrologist, and ESRD patient and family levels to improve donation and transplantation rates.

Keywords: Access and Services, Treatment System

Presenting author's disclosure statement:
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.

Recorded presentation