218408 Racial Disparities in Transplantation: What Predicts the Likelihood of Receiving a Donor?

Tuesday, November 9, 2010 : 5:15 PM - 5:30 PM

Keren Ladin, MSc , Department of Health Policy, Harvard University, Cambridge, MA
Yves Chretien, BA , Department of Statistics, Harvard University, Cambridge, MA
Erica Langnas, BA , Transplant Surgery, Beth Israel Deaconess Medical Center, Boston, MA
Joseph Lopez, BA , Harvard Medical School, Boston, MA
James Rodrigue, PhD , Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
Didier Mandelbrot, MD , Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
Martha Pavlakis, MD , Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
Douglas Hanto, MD, PhD , Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA
Introduction: Although the National Organ Transplant Act calls for equity in access to transplantation, scarcity and racial disparities persist. Despite known disparities in living-donor kidney transplantation (LDKT), the role of social networks in influencing donor willingness and eligibility remains unexplored. This study examines the role of social networks in explaining racial disparities in the rate of donor presentation and likelihood of LDKT by race.

Methods: Sample included 752 recipients (1450 person-years-on-study) and 654 donors evaluated between 2004 and 2008. Using two endpoints: (1) presentation of potential donor for evaluation, and (2) LDKT, we compare the time between recipient evaluation and either the endpoint or censoring by race. Parametric survival models and subclassification estimated time until first potential donor presentation, adjusting for socio-demographic (race, age, gender, educational attainment, employment status, and marital status), medical (functional limitations, blood type, smoking, drinking, BMI, hypertension, diabetes, and psychiatric history), and network variables (living spouse, number of siblings, and number of children).

Results: After 1 year, 45% of white and 26% of Black patients had at least one potential donor evaluated (p <0.001). Adjusting for covariates, disparities in time to first donor persisted. Among Blacks, the model estimated that 24% would receive at least a single potential donor within 1 year. However, when these black recipients' characteristics were projected onto hypothetical white patients, the model predicted that 39% would receive a donor within 1 year. After 1 year, 16% of white versus 4% of Black recipients had received LDKT (p <0.001). Lower rates of donor presentation for black recipients cannot be explained by differences in measured covariates. Differences in the role of social networks was observed, with disparities by family composition evident both by race and gender.

Conclusion: Disparities in rates of donor presentation track with race and cannot be explained by differences in measured covariates. Interventions aimed at increasing donation should be targeted within the first six months, as donation rates decrease significantly after this critical period. Ethical implications for polices aimed at mitigating disparities in organ allocation should be considered.

Learning Areas:
Biostatistics, economics
Clinical medicine applied in public health
Ethics, professional and legal requirements
Public health or related public policy
Social and behavioral sciences

Learning Objectives:
* Review and evaluate the latest research related to disparities in transplantation, particularly pertaining to disparities in donation rates between racial and ethnic groups * Examine between-group differences in the likelihood that a patient will have potential donors present within a year * Improve clinical interventions aimed at improving equity in transplantation and donation rates across all racial and ethnic groups

Keywords: Health Disparities, African American

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am qualified to present because I oversee and direct ethics and health policy research at the Transplant Institute and all studies presented.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.