A Randomized Trial and Reduce to Disparity in Live Donor Kidney Transplantation

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DESCRIPTION (provided by applicant): African Americans comprise a higher percentage of the waiting list for kidney transplantation than would be expected based on population parameters, they wait longer for kidney transplantation, and they are far less likely to receive live donor kidney transplantation (LDKT). While educational efforts have helped to expand awareness about the need for and benefits of LDKT among African Americans with ESRD, there have been very few attempts to systematically examine strategies for increasing LDKT in this patient population. The long-term goal of this research program is to improve education provided to African Americans and, thereby, increase rates of LDKT. The objective of this application is to determine the relative effectiveness of three strategies for increasing LDKT rates in African Americans. The central hypothesis is that a home-based intervention that involves the patient and significant others yields higher LDKT rates in an African American population relative to educational interventions delivered in the transplant center. Guided by strong preliminary data, this hypothesis will be tested by pursuing two specific aims: 1) Determine the clinical effectiveness of three separate LDKT educational approaches with African American patients; and 2) Determine the sociodemographic, medical, and donation-specific variables that are most strongly associated with pursuing LDKT. One hundred eighty African American adults with end-stage renal disease (ESRD) will be urn randomized to receive one of three educational interventions: home-based (HB), group-based (GB), or standard care (SC). The HB (in the home) and GB (in the transplant center) interventions will provide education to patients and their immediate and extended family members, significant others, and friends. The SC intervention (in the transplant center) mirrors what is currently done at this transplant center and will provide education to individual patients only. The primary outcome is the proportion of patients who receive LDKT. Secondary outcomes include live donor inquiries, live donor evaluations, number of potential live donors educated, and LDKT knowledge, concerns, and willingness. Recruitment rates, attrition rates, reasons for nonparticipation and attrition, protocol adherence, and participant satisfaction ratings will be gathered. The proposed research is innovative because it evaluates the relative effectiveness of three educational strategies designed to increase LDKT rates in African Americans. Findings from this study have the potential to close this racial disparity gap by identifying evidence-based educational strategies that can be used by kidney transplant centers to increase LDKT rates in African Americans. This proposal directly addresses three of the priority areas of HealthyPeople2010 (4-1, 4-5, 4-6).