Date of Award

5-2008

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Program

Health Science Administration

Research Advisor

Shelly White-Means, Ph.D.

Committee

Donna Hathaway, Ph.D. Rob Nolly, M.S. Junling Wang, Ph.D. Mona Wicks, Ph.D.

Keywords

kidney transplant, preemptive transplant, renal transplant, health disparities

Abstract

Background. This cohort study investigates whether there are inequities in the allocation of cadaver kidneys for preemptive kidney transplants (PKT) between blacks and whites.

Methods. This analysis uses descriptive statistics and univariate and multivariate analyses to identify factors associated with the determination of whether a patient receives a PKT or a conventional, post dialysis kidney transplant. The sample includes patients identified by the Centers for Medicare and Medicaid Services (CMS) as having end stage renal disease (ESRD), >19 years of age, either black or white, and receiving either a PKT (0-<6 months dialysis) or conventional transplant between January 1, 2000 and December 31, 2003 (n = 10,067) from any of the 11 organ procurement regions in the United States.

Results. Whites were more likely to receive a PKT (p<0.05). Females were 23% more likely to receive a preemptive kidney transplant as males. Those without hypertension as the primary cause of ESRD were more than 3 times more likely to receive a PKT. Those without diabetes as the primary cause of ESRD were as than 2 times more likely to receive a PKT. Those without glomerulonephritis as the primary cause of ESRD were more than 2 times as likely to receive a PKT. Interestingly, this research shows that the leading causes of ESRD in blacks and whites who received PKTs was diabetes, 22% and 31% respectively. Black conventional transplant recipients had higher rates of hypertension and diabetes than did black PKT recipients overall. White conventional kidney transplant recipients had the highest rates of diabetes (39.19%) of all groups. Of all PKT recipients, blacks received 10.76% compared with 89.24% received by whites. The mean age for blacks receiving PKTs was 48.4 years of age compared with 47 years of age for black conventional kidney transplant recipients. The mean age for whites, both PKT and conventional transplant recipients was approximately 49 years of age. Higher percentages of PKTs took place in the northeastern and southeastern regions (UNOS regions 2 and 3) of the United States. The majority of PKT recipients, both blacks and whites, received their donor organs from whites. Blacks received 69.42% white donor, organs compared with 77.61% received by whites. Blacks did receive 17.43% of their donor organs from blacks, with whites receiving approximately 6% of their organs from blacks. For those receiving PKTs during the study period, 86% of whites and 81% of blacks were still alive with functioning grafts at the conclusion of the study period. Medicare A and B as the primary insurance and those who had Medicare as a secondary payer each did reflect statistical significance as indicators of being less likely than patients insured otherwise.

Conclusion. From this analysis it is concluded that a disparity exists in the allocation of PKTs between blacks and whites. These results indicate that blacks are less likely to receive a PKT than their white ESRD counterparts, females are more likely to receive a preemptive kidney transplant than males, and that both males and females are more likely to receive a PKT if they do not have a diagnosis as the primary cause of their ESRD of hypertension, diabetes and/or glomerulonephritis. These results suggest that there may be remediable inequities in the current system relating to the policies of UNOS and that PKTs can be allocated in a more equitable manner.

DOI

10.21007/etd.cghs.2008.0036

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