Racial disparities in living kidney donation among South Carolinians: The effect of health conditions, individual behavior, and family attributes.

摘要

Background. End stage renal disease (ESRD) is the number one cause of kidney failure and the driving force behind the need for kidney transplantation. South Carolina (SC) has one of the highest prevalence rates of ESRD among African Americans, which comprise 65% of the population on dialysis, 70% of the transplant wait list, but only 30% of the live donors. Increasing live donation is paramount in decreasing the magnitude of this disparity. However, the rate of live donations is affected by factors related to the values and perceptions of kidney donors and recipients, as well as the conditions surrounding deceased donor kidney donations. This research aimed to (1) determine if there are differences in the reasons and rates at which African American and non-African American potential live kidney donations are aborted and (2) described previous kidney donors thoughts and feelings about past kidney donations. Additionally, this research (3) assessed racial differences in coping behavior and 4) the effect of family structure on the willingness of patients to ask for a living kidney donation.;Methods. A retrospective database and chart review of all patients that were referred for potential live kidney donation was performed. Telephone interviews were conducted with previous kidney donors. Survey packets including the The Brief Cope, MUSC Living Organ Donor Survey, and FACES II were administered prospectively to potential kidney transplant recipients.;Results. A higher number in the African American group were declined as candidates for kidney donation due to morbid obesity and a significantly higher number of potential African American recipients were too ill to transplant. Among potentially viable candidates there was a 30% drop out rate. Family type, cohesion, and adaptability showed no differences across race and was not related to the potential recipient's willingness to ask for a live donation. Only half of ESRD patients were willing to ask for a live organ donation and unmarried patients were half as likely to ask for a living donation. African Americans cope with the need for a kidney transplant differently than non-African Americans. Potential African American kidney recipients are more likely to deny the need for a transplant and are less accepting of their situation.;Conclusions. The high drop-out rate among African American potential kidney donors indicates there is a lack of willing donors and that the disparity is not simply caused by medically unsuitable candidates. Transplant programs would benefit by increasing follow-up of potential donors, improving patient coping skills, which may affect their perception of the need for transplant and their persuasiveness in asking for live donations, and increasing patient's self-worth. Future endeavors should focus on overcoming the identified barriers to maximize the living donation potential.