Abstract
Living donor kidney transplantation is a superior treatment option for those with end stage kidney disease, but most transplants are from deceased donors. Securing a living donor for living donor kidney transplantation requires effective, well-timed communication which many may find difficult or intimidating. This study uses segmentation analysis and an innovative marketing technique called perceptual mapping to create three dimensional models to compare living donor kidney transplant perceptions by self-reported health status in 160 end-stage kidney disease dialysis patients of two hospital-based dialysis units and an online forum through cross-sectional surveys. Findings indicate patients with poor self-reported health status are more concerned with not knowing what to say or being afraid a person would say no to living donor kidney transplantation. They are also concerned about the donor’s ability to care for family or donate in the future. They are, however, more likely to see benefits of living donor kidney transplantation, including the kidney lasting longer and having a greater quality of life. Findings reveal messages that could be emphasized in interventions to enhance the ability to ask for living donor kidney transplantation, especially in those assessed as having poor health status. Segmentation analysis and perceptual mapping methods can provide a more nuanced look at how best to develop intervention content to increase living donor kidney transplant.
Highlights
Living donor kidney transplantation (LDKT) is the superior treatment option for those living with end-stage kidney disease (ESKD) as it reduces time waiting for a transplantable kidney, improves patient outcomes and quality of life, and is the most cost-effective modality compared to dialysis or deceased donor kidney transplant (DDKT) (Gozdowska et al, 2016; Landreneau et al, 2010)
Thirty nine percent of participants had multiple health insurance types (e.g., Medicare and Medicaid), 24% had received a kidney transplant in the past but were currently on dialysis, and on average participants had been on dialysis for 6 years
An examination of the distances from the group “Self” and other concepts support several findings from past research, including patients’ struggles finding the best way to communicate their need for a kidney transplant and requesting living donation, and concerns about the well-being of potential donors (Alvaro et al, 2008; Weng et al, 2010). These analyses extend our understanding of patient-level facilitators and barriers to LDKT by further elucidating relationships among concepts related to living donation, and how they are alike or different based on self-reported health status
Summary
Living donor kidney transplantation (LDKT) is the superior treatment option for those living with end-stage kidney disease (ESKD) as it reduces time waiting for a transplantable kidney, improves patient outcomes and quality of life, and is the most cost-effective modality compared to dialysis or deceased donor kidney transplant (DDKT) (Gozdowska et al, 2016; Landreneau et al, 2010). While structural barriers do exist (Purnell et al, 2012; Sandal et al, 2019), such as lack of health insurance or access to nephrology specialists, often individuals with kidney disease avoid LDKT discussions or are unwilling to pursue LDKT due to misunderstandings and misperceptions of its risks and benefits (Rodrigue et al, 2008; Traino, 2014; Davis et al, 2017; Cabacungan et al, 2020) These communication barriers complicate the communicative processes needed to identify and recruit living donors, including the belief that receiving a donated kidney from a family member may take it away from another family member in the future (Rodrigue et al, 2008), concern for the health and wellbeing of the donor after donation, and being perceived as a burden (Alvaro et al, 2008). The desire to survive to be present for family supersedes these concerns for others (Stothers et al, 2005)
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