A Program to Increase Living Donations in African Americans

增加非裔美国人活体捐赠的计划

• 批准号: 8124926
• 负责人: PRABHAKAR K BALIGA
• 金额: $ 19.98万
• 依托单位: MEDICAL UNIVERSITY OF SOUTH CAROLINA
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-15 至 2012-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8124926
• 关键词: Address; Adverse effects; African American; Anxiety; Applications Grants; Area; Caring; Characteristics; Chronic Kidney Failure; Communication; Communities; Complex; Comprehension; Consent; Coping Skills; Dialysis procedure; Disease; Drops; Early identification; Education; Emotional; Emotions; End stage renal failure; Ensure; Evaluation; Family; Family member; Focus Groups; Fright; Funding; Future; Health Personnel; Healthcare Market; High Prevalence; Human Resources; Individual; Intervention; Kidney; Kidney Transplantation; Knowledge; Lead; Learning; Life; Living Donors; Mediation; Medical; Medical center; Minority; Morbid Obesity; Operative Surgical Procedures; Organ Donor; Patients; Persons; Physicians; Population; Process; Race; Readiness; Religion and Spirituality; Resources; Rural; Social Workers; South Carolina; Surveys; Testing; Time; Training; Transplant Recipients; Transplantation; Trust; Uncertainty; United Network for Organ Sharing; Work; care systems; experience; health literacy; high school; improved; information processing; intervention program; literacy; member; prevent; programs; prospective; response; skills; volunteer; willingness

DESCRIPTION (provided by applicant): South Carolina (SC) has one of the highest rates of end stage renal disease among African Americans (AA). These patients constitute 70% of the patients waiting for a transplant but receive only 50% of total transplants and the lowest number of living donor transplants. In our previously funded grant proposal, we wanted to identify specific barriers to living donation that exist in the AA community and sought to overcome them by an active intervention program. We observed a three fold increase in the number of living donors but still had a 30% drop out rate (patients who did not complete evaluation after volunteering to donate). A critical analysis of our educational program suggested that the health care provider had to be better prepared as educators to tailor the information to the potential donor's readiness to learn. In addition, to allow for sufficient time to help the transplant recipient identify potential donors, and enable the donor education to be personalized according to each individual's readiness to learn, it is anticipated that starting the donor identification and education process early in the disease process will allow maximal opportunity for communication with patients and families. Finally, the education that we currently provide may be stressful and difficult to absorb particularly for a healthy donor. We will replace much of the information currently transmitted with process guidance provided by a "patient navigator". Our overall Hypothesis is that live kidney donation in African Americans will increase with the utilization of 1) educators who are professionally trained to work with AA families, 2) early identification and education of AA donors in potentially "high yield" settings, and 3) navigation of the AA donors by these educators. Health Care Providers will receive professional training for working with AA patients and families. The skills include educating by assessing readiness, appropriately pacing information, assessing understanding, accepting responses and probing for deeper concerns. A Community Advisory Board will be utilized to ensure that the educators are sensitive to the needs of minorities. Patient Educators will be placed at the offices of nephrologists to allow early access to patients with end stage renal disease nearing dialysis. This early contact will allow more time to establish trust between the educator and the patient and prospective donors. Patient navigators will help the potential donors move successfully through the complex evaluation process, while at the same time being available to educate, reinforce previous learning, and provide emotional support for the donor and other family members. Racial disparities continue to exist in kidney transplantation. Increasing the number of living donors in the AA community will result in more transplants in this racial group which will ultimately improve graft and patient survival and lower waiting times.

描述(由申请人提供)： 南卡罗来纳州(SC)是非裔美国人(AA)中终末期肾病发病率最高的地区之一。这些患者占等待移植的患者的70%，但只接受了总移植的50%，是活体捐赠者移植数量最少的。在我们之前资助的赠款提案中，我们希望确定AA社区中存在的活体捐赠的具体障碍，并试图通过积极的干预计划来克服这些障碍。我们观察到活体捐赠者的数量增加了三倍，但仍有30%的失败率(自愿捐献后未完成评估的患者)。对我们的教育项目的一项批判性分析表明，作为教育工作者，医疗保健提供者必须做好更好的准备，根据潜在捐赠者的学习意愿定制信息。此外，为了有足够的时间帮助移植受者确定潜在的捐赠者，并使捐赠者的教育能够根据每个人的学习意愿进行个性化，预计在疾病过程的早期开始捐赠者的识别和教育过程将使与患者和家人的沟通有最大的机会。最后，我们目前提供的教育可能压力很大，很难吸收，特别是对健康的捐赠者来说。我们将用“患者导航员”提供的流程指导来取代目前传输的大部分信息。我们的总体假设是，非裔美国人的活体肾脏捐赠将随着1)受过与AA家庭合作的专业培训的教育工作者的使用而增加，2)在潜在的“高收益”环境中及早识别和教育AA捐赠者，以及3)这些教育者导航AA捐赠者。卫生保健提供者将接受与再生障碍性贫血患者及其家人合作的专业培训。这些技能包括通过评估准备情况、适当调整信息步调、评估理解、接受回应和探索更深层次的问题来进行教育。将利用一个社区咨询委员会来确保教育工作者对少数群体的需求敏感。患者教育人员将被安排在肾病学家的办公室，以便及早接触接近透析的终末期肾病患者。这种早期接触将使教育者与患者和潜在捐赠者之间有更多的时间建立信任。患者导航员将帮助潜在捐赠者顺利通过复杂的评估过程，同时可以教育、加强先前的学习，并为捐赠者和其他家庭成员提供情感支持。在肾移植方面，种族差异仍然存在。增加AA社区中活体捐赠者的数量将导致这一种族群体中更多的移植手术，这最终将提高移植物和患者的存活率，并缩短等待时间。

项目成果

Barriers facing patients referred for kidney transplant cause loss to follow-up.

• DOI: 10.1038/ki.2012.255
• 发表时间: 2012-11
• 期刊: Kidney international
• 影响因子: 19.6

Racial comparisons of everolimus pharmacokinetics and pharmacodynamics in adult kidney transplant recipients.

• DOI: 10.1097/ftd.0b013e31829a7a7c
• 发表时间: 2013-12
• 期刊: Therapeutic drug monitoring
• 影响因子: 2.5
• 作者: Taber DJ;Belk L;Meadows H;Pilch N;Fleming J;Srinivas T;McGillicuddy J;Bratton C;Chavin K;Baliga P
• 通讯作者: Baliga P

Racial disparities in living kidney donation: Is there a lack of willing donors or an excess of medically unsuitable candidates?

• DOI: 10.1097/01.tp.0000232693.69773.42
• 发表时间: 2006-10-15
• 期刊: TRANSPLANTATION
• 影响因子: 6.2
• 作者: Lunsford, Shayna L.;Simpson, Kit S.;Baliga, Prabhakar K.
• 通讯作者: Baliga, Prabhakar K.

Racial differences in the living kidney donation experience and implications for education.

活体肾脏捐赠经历的种族差异及其对教育的影响。

• DOI: 10.1177/152692480701700312
• 发表时间: 2007
• 期刊: Progress in transplantation (Aliso Viejo, Calif.)
• 作者: Lunsford,ShaynaL;Shilling,LillessM;Chavin,KennethD;Martin,MargaretS;Miles,LuciaG;Norman,MicheleL;Baliga,PrabhakarK
• 通讯作者: Baliga,PrabhakarK

Can family attributes explain the racial disparity in living kidney donation?

家庭属性可以解释活体肾脏捐赠的种族差异吗？

• DOI: 10.1016/j.transproceed.2007.03.017
• 发表时间: 2007
• 期刊: Transplantation proceedings
• 影响因子: 0.9
• 作者: Lunsford,SL;Simpson,KS;Chavin,KD;Mensching,KJ;Miles,LG;Shilling,LM;Smalls,GR;Baliga,PK
• 通讯作者: Baliga,PK