Race, Experience of Discrimination, and Other Non-Medical Factors Predict Differences in Acceptance for Kidney Transplantation.

Abstract

African Americans (AA) take significantly longer to complete evaluation and be accepted for kidney transplant (KT) than Whites (WH). Race disparities persist even when medical factors are controlled, and non-medical reasons for race disparities are poorly understood. We collected primary data from patients in a large KT center to: (a) compare rates of KT acceptance and time to KT acceptance; and (b) assess if demographics, cultural factors (e.g., perceived discrimination, medical mistrust), psychosocial characteristics (e.g., anxiety, depression), and transplant knowledge (TK) predict time to acceptance. Prospective study, in which patients completed telephone interviews after their first clinic appointment, and again after they were accepted or found ineligible for KT. AA (n=259) were younger, had lower incomes, were more likely to be on public insurance, and less likely to be married than WH (n=773). AA experienced significantly more healthcare discrimination, perceived more overall healthcare racism, had higher levels of medical mistrust, greater family loyalty, and more religious objections to KT than WH (ps<.01). WH had higher KT knowledge (p<.001). Although WH were more likely to accept a living donor volunteer (p<.01), AA were more willing to ask someone for a live kidney donation (p<.001). AA were less likely to be accepted for KT (34 vs 57%) and took significantly longer to be accepted for transplant (median=400 vs 295 days) than WH (ps<.001). AA race, older age, lower education, lower income, being on hemodialysis, and experiencing discrimination in healthcare predicted a lower KT acceptance rate. But, private insurance, having a living donor at the start of evaluation, greater social support, and more KT knowledge predicted a higher acceptance rate. Although data collection is ongoing, and results are preliminary, we suggest that interventions to address racial disparities in KT should incorporate non-medical risk factors in patients. Suggestions for interventions include: fast-track evaluation for at-risk patients, increase contact with patients to ensure follow-through with necessary testing, facilitate scheduling of appointments, recruit former recipients as peer mentors, encourage early evaluation of living donors, and enhance the cultural competency of transplant teams to learn about the reasons that patients may take longer to complete evaluation.