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

• Authors: Stephen Pastan, Emory University; Rachel Patzer, Emory University; Adam Wilk, Emory University; T Browne, University of South Carolina; L McPherson, Rollins School of Public Health; S Retzloff, Emory University School of Medicine; A Darius, Rollins School of Public Health; A Cruz, IPRO ESRD Network of the South Atlantic; S Wright, IPRO ESRD Network of the South Atlantic; JC Gander, Kaiser Permanente; AA Berlin, Simultaneous Kidney Pancreas Transplant patient advocate
• Journal Title: Kidney Medicine
• Volume: Volume 3, Number 5
• Publisher: (publisher) | 2021-09-01, Pages 799-807.e1
• Type of Work: Article
• Publisher DOI: http://doi.org/10.1016/j.xkme.2021.04.017
• Keywords: Access; dialysis; interdisciplinary; transplant; wait-list

Abstract

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.