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Author Notes:

Rachel E. Patzer, PhD, Department of Surgery, Emory University School of Medicine, and Department of Epidemiology, Rollins School of Public Health, Emory University, 101 Woodruff Circle, 1525 WMB, Atlanta, GA 30322. Email: rpatzer@emory.edu

Research idea and study design: TB, LM, JCG, AAB, SOP, REP; data acquisition: LM, SR, SW AC; data analysis/interpretation: TB, AD, LM, SR, SW, AW, SOP, AC, REP; statistical analysis: LM, SR, REP. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

The authors acknowledge the assistance of the Southeastern Kidney Transplant Coalition in participating with data collection and survey design. The authors would like to specifically acknowledge the Coalition members who heavily contributed to these tasks: Randy Detwiler (University of North Carolina Center for Transplant), Derek DuBay (Medical University of South Carolina), Matthew Ellis (Duke University Transplant Center), Chris Fotiadis (Carolinas Health), Erica Hartmann (Piedmont Transplant Institute), Heather Jones (Vidant Medical Center), Laura Mulloy (Augusta University Health Transplant Center), Amber Reeves-Daniel (Wake Forest Health), and Carlos Zayas (Augusta University Health Transplant Center). All authors have approved the final manuscript and certify that this manuscript represents valid work and has not been previously published.


Research Funding:

The authors declare that they have no relevant financial interests.


  • Access
  • dialysis
  • interdisciplinary
  • transplant
  • wait-list

Improving Access to Kidney Transplantation: Perspectives From Dialysis and Transplant Staff in the Southeastern United States

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Journal Title:

Kidney Medicine


Volume 3, Number 5


, Pages 799-807.e1

Type of Work:

Article | Final Publisher PDF


Rationale & Objective: There are many barriers to meeting the goal of increasing kidney transplants in the United States. It is important to understand dialysis and transplant center providers’ existing practices and identified barriers to increasing the number of dialysis patients who are evaluated for and get wait-listed for a transplant. Study Design: Cross-sectional survey of dialysis unit and transplant center staff in End Stage Renal Disease Network 6 (Georgia, North Carolina, South Carolina). Setting & Participants: Ninety-one transplant staff from all 9 transplant centers in the region and 421 dialysis staff from 421 facilities responded to the survey. Predictors: N/A Outcome: Provider perceptions of barriers faced by patients in the kidney transplant evaluation process and suggestions for improving care. Analytical Approach: Mixed methods. Descriptive analyses of responses to multiple-choice questions and qualitative analysis of open-ended survey responses. Results: The top 5 barriers to kidney transplantation as reported by transplant staff were transportation (63.7%), low health literacy (50.5%), lack of understanding about the transplant process (37.4%), distance to transplant center (29.7%), and low socioeconomic status (28.6%). When asked how dialysis units can help patients complete the evaluation process, the most common responses from transplant center staff were educating patients about transplant (54%), helping patients through steps in the process (35%), and better communication with transplant centers (15%). When dialysis unit staff were asked what could be done to help the facility improve its transplant wait-list rate, the most common responses were educational materials for patients and staff (55%), better communication with transplant centers (12%), and transportation and financial assistance (9%). Limitations: Survey responses are from 1 end stage renal disease network. Conclusions: Dialysis units, transplant centers, and ESRD networks can work together to help patients address key barriers to transplantation to improve the country's transplantation rate.

Copyright information:

© 2021 The Authors

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (https://creativecommons.org/licenses/by-nc-nd/4.0/rdf).
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