Study shows many unaware that racial disparities exist on kidney transplant waitlists
Tuesday, May 22, 2018
Racial disparity in waitlisting prevents many Americans from getting the kidney transplants they need. Healthcare providers at dialysis facilities play an important role in kidney transplant waitlisting, but very little is known about their level of awareness of these racial disparities.
Results from a new study suggest that many providers are unaware of racial disparities in kidney transplant waitlisting. Specifically, they found that awareness was low among white providers and nurse managers.
Racial disparity in kidney transplantation waitlisting has been a longstanding problem.
In December 2014, the United Network for Organ Sharing (UNOS) implemented new rules for the Kidney Allocation System (KAS) with the intent of addressing a number of problems, including racial disparities that existed in kidney transplantation among waitlisted patients.
The old nationwide rules for organ allocation used a "first-come, first-served" algorithm system, based on the length of time patients were on the waiting list. The system allowed a handful of exceptions that moved patients up or down in the queue.
Changes to KAS placed more importance on time spent on dialysis than on time spent on the waiting list. By making the change, UNOS hoped to increase transplant to minorities, who frequently experience delays in placement on the waiting list after beginning dialysis.
Research shows that the changes are helping to increase transplant rates for deceased donor kidney recipients. One study showed that transplant rates jumped 19 percent for blacks and 13 percent for Hispanics in the first year after the KAS changes. Still, disparities exist.
Providers Unaware of Racial Disparities — Even in their Own Facilities
Led by Joyce J. Kim from the Emory University School of Medicine in Atlanta, researchers wanted to examine awareness of racial disparities that exist in kidney transplant waitlisting among healthcare professionals.
The researchers conducted a cross-sectional analysis of a 2016 survey, in which 655 providers answered "yes" or "no" to the question: "Nationally, do you think that African Americans currently have lower waitlisting rates than white patients on average?" The scientists defined awareness of national racial differences in waitlisting as responding "yes."
The team also investigated providers’ perceptions of racial disparities in waitlisting at the providers’ own facilities.
The scientists found that 19 percent of the providers surveyed were unaware of the national racial disparity in waitlisting. Specifically, half of the 113 medical directors, 11 percent of 327 nurse managers and 16 percent of 215 other providers were not aware of national racial disparities.
The team of researchers determined that the likelihood of unawareness is higher among nurse managers than it is in medical directors and for white more than for black providers, at odds ratios 7.33 and 2.64, respectively.
Facilities with a low percentage of blacks and those in the southern portions of the country were also more apt to be unaware of the racial disparities, at 1.86 and 3.05, respectively.
Racial differences in waitlisting exceed 5 percent in a quarter of the facilities surveyed; only 5 percent of survey respondents were aware of the racial disparities occurring in these facilities.
"Provider awareness of racial disparities in kidney transplant waitlisting was low, particularly among staff who may have more routine contact with patients," the authors concluded.
The researchers published their results online in the Clinical Journal of the American Society of Nephrology.
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