Access to Renal Transplantation among African-Americans and OtherUnderrepresented Groups: The Role of Patient Choice of Treatment Modality in End Stage Renal Disease. Executive Summary and Final Report

摘要

The research explored access to the cadaveric transplant waiting list amongpatients with End State Renal Disease (ESRD), using survey and ethnographic interviews to compare how different patients enter the waiting list whole receiving center-based hemodialysis treatment. The study was designed to identify social and psychological factors which may lie behind the nationally observed sociodemographic difference in waiting list access; women, older patients, and African American ESRD patients have been shown to enter the waiting list at lower rates then younger white men. After conducting indepth medical record reviews on 297 hemodialysis patients in 3 Baltimore dialysis units, we interviewed 114 of the 151 transplant-eligible patients. We also conducted staff and physician interviews about patients. Analyses compared listed patients to those not listed, and unlisted patients who wanted transplant with those who did not. Unlisted patients were more likely to be older and female. They were no more likely to be African-American, but were more likely to report lifetime experience with racial discrimination. Listed patients were more likely to report lifetime experience with gender discrmimination, as well as to disagree that losing a transplant after one year would not be worth it. Among unlisted patients, 44% wanted a transplant, with age, racial and gender discrimination, and beliefs about advantage in the organ allocation system associated with not wanting a transplant.