Modifiable factors affecting racial disparities in live kidney donation

描述(由申请人提供)：肾衰竭的最佳治疗方法通常是活体供肾移植(LDKT)，与长期透析相比，它平均多提供10年的生命。不幸的是，在接受LDKT方面仍然存在很大的种族/族裔差距。黑人和西班牙裔占所有透析患者的58%以上，但接受LDKT的患者不到28%。LDKT差异的一个很少被研究且可能是关键原因是黑人和西班牙裔捐赠者志愿者(有兴趣捐赠活体肾脏的人)完成多步骤捐赠者评估并实际捐献的可能性较低。虽然少数族裔捐赠者志愿者更有可能有捐献的医疗禁忌症，但他们也更有可能停止捐赠者评估或拒绝参与配对交换(允许使用免疫不相容的供受者对进行LDKT的计划)。基于有限的先前研究，捐赠者评估的结果可能特别受到几个潜在的可改变的个人和医疗保健系统因素的影响，例如捐赠者志愿者的捐赠动机、健康素养、关于捐赠的知识/教育、对患者护理经验的满意度以及捐赠的社会经济障碍。然而，这些因素还没有在一个强大的、多中心的和多样化的捐赠者志愿者队列中进行前瞻性的研究。这项研究的目的是确定可修改的个人和系统因素的差异如何与黑人和西班牙裔捐赠者志愿者实际捐献的可能性较低相关。我们的总体假设是，黑人或西班牙裔捐赠者志愿者更有可能停止捐赠者评估，这是由于可修改的差异，即(1)在评估开始时已经存在，(2)在评估过程后期出现。为了检验这一假设，我们提出了一种序贯混合方法研究。首先，我们将对以前停止捐助者评价的捐助者志愿者进行定性访谈，以确定中止捐助者评价的所有可能的可修改原因(目标1)。然后，在定量部分，我们将在新泽西州和加利福尼亚州的两个大型移植中心对2800名活体肾脏捐赠者志愿者进行前瞻性队列研究。在575名黑人、875名西班牙裔和1350名白人捐赠者志愿者中，我们将确定存在于 在捐助者评价开始时(目标2)或在评价期间(目标3)，还可确定在成功完成捐助者评价(目标4)和实际捐赠后可修改因素的影响，直接或通过配对交换(目标5)。在本研究结束时，我们将了解黑人、西班牙裔和白人活体捐赠者志愿者在潜在的可修改的社会、行为和医疗服务特征方面的不同之处，以及这些因素如何影响评估和实际捐赠的完成。我们的结果可以推广到美国的230个肾移植中心，这将使我们能够设计未来的干预措施，以改善 教育、支持和照顾活体捐赠者志愿者，以最终减少LDKT中的种族/族裔差异。

DESCRIPTION (provided by applicant): The best treatment for kidney failure is usually a live donor kidney transplant (LDKT), which provides an average of 10 additional years of life compared to staying on chronic dialysis. Unfortunately, large racial/ethnic disparities persist in receipt of LDKTs. Blacks and Hispanics comprise over 58 percent of all dialysis patients but receive less than 28 percent of LDKTs. A little-studied and likely crucial cause of LDKT disparities is the lower likelihood that Black and Hispanic donor volunteers (persons interested in donating a live kidney) will complete the multi-step donor evaluation and actually donate. While minority donor volunteers are more likely to have medical contraindications to donation, they are also much more likely to discontinue the donor evaluation or decline participation in paired exchange (programs that permit LDKT using immunologically incompatible donor-recipient pairs). Based upon limited prior research, the outcomes of the donor evaluation may be especially affected by several potentially modifiable individual and health care system factors, such as donor volunteers' motivation to donate, health literacy, knowledge/education about donation, satisfaction with the patient care experience, and socioeconomic barriers to donation. These factors, however, have not been prospectively examined in a well-powered, multi-center, and diverse cohort of donor volunteers. The objective of this study is to determine how differences in modifiable individual and system factors are associated with Black and Hispanic donor volunteers' lower likelihood of actually donating. Our overall hypothesis is that donor volunteers who are Black or Hispanic are more likely to discontinue the donor evaluation, due to modifiable differences that either (1) are already present at the start of the evaluation, o (2) arise later in the evaluation process. To test this hypothesis, we propose a sequential mixed methods study. First, we will perform qualitative interviews of donor volunteers who previously discontinued their donor evaluations, to identify all the potentially modifiable causes of discontinuation of the donor evaluation (Aim 1). Then, in the quantitative component, we will perform a prospective cohort study of 2,800 live kidney donor volunteers at two large transplant centers in New Jersey and California. Among 575 Black, 875 Hispanic, and 1,350 White donor volunteers, we will determine differences in potentially modifiable factors that are present at the start of the donor evaluation (Aim 2) or arise during the evaluation (Aim 3), and also determine the impact of modifiable factors upon successful completion of the donor evaluation (Aim 4) and actual donation, directly or via paired exchange (Aim 5). At the end of this study, we will understand how Black, Hispanic, and White live donor volunteers differ in their potentially modifiable social, behavioral, and health services characteristics and how these factors impact both completion of the evaluation and actual donation. Our results, generalizable to the 230+ kidney transplant centers in the U.S., will enable us to design future interventions to improve the education, support, and care of live donor volunteers, to ultimately decrease racial/ethnic disparities in LDKT.