Understanding Race and Gender Barriers to Live Kidney Donation Is Key to Closing

Understanding Race and Gender Barriers to Live Kidney Donation Is Key to Closing the Gap, Researchers Say

Published on 20 March 2009, 10:00 Last Update: 2 day(s) ago by Insciences

Researchers at Wake Forest University Baptist Medical Center have identified several potentially modifiable barriers to successful kidney donation among women and blacks, including obesity and failure to complete the donor evaluation. Understanding these barriers may help close the gap between potential donors and patients in need of healthy organs, researchers say.

Published in Clinical Transplantation 2009, the study reflects the findings of researchers who reviewed the medical files of potential living kidney donors (LKDs) from 2003 to 2006 at Wake Forest Baptist, which is ranked one the nation’s top 50 hospitals for care of kidney disease by U.S.News and World Report. The analysis explores reasons why people who begin the LKD evaluation process do not proceed to successful donation, said Amber Reeves-Daniel, D.O., a board-certified nephrologist, medical director of Wake Forest Baptist’s Living Donor Kidney Program, and the study’s lead author. The study also identifies differences according to race and gender.

Until now, little attention has been paid to determining why potential donors drop out of the evaluation process, which includes completion of a demographic and medical history survey, blood and tissue typing, blood pressure measurement and body mass index (BMI) calculation. Understanding this is important because research has shown that women and blacks are less likely than men and whites to receive either a live or deceased donor kidney. Even when they do get the transplant, women and blacks face disproportionately longer waiting times for it.

For the study, researchers reviewed the files of 541 subjects who began the live kidney donation process but never actually donated. The reasons for non-donation were documented in their files. More than half (385) of the individuals were female. The most common reasons identified for non-donation were obesity (20.7 percent), blood group incompatibility with the potential recipient (20.2 percent) and use of a kidney from another donor, either living or deceased, for transplant (15 percent).

In analyzing gender differences among the files, researchers found that females were more commonly excluded from being donors because of reduced kidney function (7.9 percent of females compared to .09 percent of males), and they failed more often to complete the donor evaluation process (6.4 percent of females compared to 1.8 percent of males). The most common reason cited to explain why potential male donors did not end up donating was that their intended recipient received an organ from a different donor (19 percent of males vs. 12.1 percent of females).

In analysis by race, significantly more blacks were excluded from donating because of obesity (30.4 percent of blacks compared to 16.6 percent of whites) and for having incomplete evaluations (12.3 percent vs. 1.8 percent of whites). Whites were more likely to be excluded due to kidney stones (7.3 percent of whites compared to 1.5 percent of blacks) and because their intended recipients received organs from different donors (18.2 percent of whites vs. 6.5 percent of blacks).

Racial differences by gender were similar to racial differences overall. Black women were more likely than white women to be excluded from donating because of obesity (37.5 percent of black women compared to 16.9 percent of white women), and more likely to have an incomplete evaluation (17.5 percent vs. 2.7 percent). White women, meanwhile, were more likely to have their intended recipient receive an organ from a different donor (15.6 percent of white women vs. 3.8 percent of black women). Among men, more blacks were excluded because they failed to complete the evaluation (5.2 percent black men compared to 0.6 percent of white men).

During the study period, 85 individuals donated, resulting in a rate of successful donation of 13 percent.

“More study is needed,” said Reeves-Daniel, an assistant professor of nephrology. “Identifying those barriers to donation that can be overcome may help us improve access to transplantation for all transplant candidates. With end-stage kidney disease escalating, along with the unrelenting growth of the renal transplant list, the need for living kidney donors has never been greater.”

Co-researchers for the study were Patricia Adams, M.D., Dean Assimos, M.D., Kurt Daniel, D.O., Carl Westcott, M.D., Jeffrey Rogers, M.D., Alan Farney, M.D., Robert Stratta, M.D., Erica Hartmann, M.D., and Sharon Alcorn, R.N., all of Wake Forest Baptist.

-- http://insciences.org/article.php?article_id=3528