The U.S. Department of Health and Human Services in its most recent public health
initiative established eliminating health disparities as a priority area with addressing
the social determinants of health (SDOH) as an objective to advance health equity.
1
Significant disparities based on race and ethnicity exist for patients with end-stage
renal disease (ESRD) throughout their disease process.
2
In particular, the optimal treatment for ESRD, living donor kidney transplantation,
has seen significant disparities increase over the last 2 decades.
3
While national policy has focused on improving equity in the deceased donor allocation
system with the New Kidney Allocation System and broader sharing, fewer national policy
interventions have been effective at increasing living donation for minority patients.
3
,4
One effective single-center mechanism for increasing living donation rates among
minority patients has been instituting an advocacy program for potential recipients;
however, recent work has shown this may not be as beneficial for self-advocates.
5
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References
- Leading Health Indicators 2030 : Advancing Health, Equity, and Well-Being.National Academies Press, Atlanta2020
- Social determinants of racial disparities in CKD.J Am Soc Nephrol. 2016; 27: 2576-2595https://doi.org/10.1681/ASN.2016010027
- Association of race and ethnicity with live donor kidney transplantation in the United States from 1995 to 2014.JAMA. 2018; 319: 49-61https://doi.org/10.1001/jama.2017.19152
- The broader sharing of deceased donor kidneys is an ethical and legal imperative.J Am Soc Nephrol. 2020; 31: 1174-1176https://doi.org/10.1681/ASN.2020020121
- Enhanced advocacy and health systems training through patient navigation increases access to living-donor kidney transplantation.Transplantation. 2020; 104: 122-129https://doi.org/10.1097/TP.0000000000002732
- Greater community vulnerability is associated with poor living donor navigator program fidelity.Surgery. 2022; 172: 997-1004
Article info
Publication history
Published online: June 24, 2022
Accepted:
May 12,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Greater community vulnerability is associated with poor living donor navigator program fidelitySurgeryVol. 172Issue 3
- PreviewCommunity-level factors contribute to living donor kidney transplantation disparities but may also influence the interventions aimed to mitigate these disparities. The Living Donor Navigator Program was designed to separate the advocacy role from the patient in need of transplantation—friends/family are encouraged to participate as the patients’ advocates to identify living donors, though some of the patients participate alone as self-advocates. Self-advocates have a lower living donor kidney transplantation likelihood compared to the patients with an advocate.
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