Short-Term Impact of an Educational Program Promoting Live Donor Kidney Transplantation in Dialysis Centers

Abstract

Context

Given the shortage of kidneys available for transplantation, a community-based intervention trial was implemented to assess the impact of an educational program on patients' access to live donor kidney transplantation (LDKT).

Objective

To compare the short-term impact of a basic intervention and an enhanced intervention on patients' readiness to pursue LDKT.

Design

Baseline data and data from 1 week after interventions were analyzed.

Participants

214 transplant-eligible hemodialysis patients attending 14 dialysis facilities in Maryland, Virginia, and Pennsylvania.

Interventions

In the basic intervention, 107 patients watched a 10-minute videotape on the experience of recipients and live donors of a kidney. In the enhanced intervention, 107 patients watched the same videotape and had a discussion with a health educator on the risks and benefits of LDKT, who could be a donor, and how to address the barriers they were encountering when seeking a live kidney donor.

Main outcome measure

Patient reported whether they were considering LDKT, had talked with family or friends about LDKT, and had asked someone for a kidney.

Results

Over half of transplant-eligible patients were not pursuing LDKT at baseline (64% in the basic intervention group, 61% in the enhanced intervention group). One week after the intervention, the odds of considering LDKT were higher among African Americans (odds ratio [OR], 2.28; confidence interval [CI], 1.22–4.25), younger patients (OR, 0.94; CI, 0.91–0.97), and patients who spent less time on dialysis (OR, 0.90; CI, 0.83–0.97). The odds of asking for a kidney were higher among African Americans (OR, 4.94; CI, 2.54–9.60) and patients who perceived they were in poor to fair health (OR, 3.30; CI, 1.12–9.67).

Conclusions

Although both interventions helped patients consider LDKT and ask for a kidney, more time and expanded educational content might be needed to facilitate patients' discussion about LDKT with their loved ones.

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References

Langone

Helderman

. Disparity between solid-organ supply and demand. N Engl J Med. 2003;349(7):704–706.

Tarantino

. Why should we implement living donation in renal transplantation? Clin Nephrol. 2000;53(4 suppl):55–63.

Cecka

Terasaki

. Living donor kidney transplants: Superior success rates despite histoincompatibilities. Transplant Proc. 1997;29(1–2):203.

Pradel

Limcangco

Mullins

Bartlett

. Patients' attitudes about living donor transplantation and living donor nephrectomy. Am J Kidney Dis. 2003;41(4):849–858.

Pradel

Mullins

Bartlett

. Exploring donors' and recipients' attitudes about living donor kidney transplantation. Prog Transplant. 2003;13(3):203–210.

Kranenburg

Zuidema

Weimar

. Psychological barriers for living kidney donation: How to inform the potential donors? Transplantation. 2007;84(8):965–971.

Murray

Conrad

Bayley

. Perceptions of kidney transplant by persons with end stage renal disease. ANNA J. 1999;26(5):479–83, 500; discussion 484.

Shilling

Norman

Chavin

. Healthcare professionals' perceptions of the barriers to living donor kidney transplantation among African Americans. J Natl Med Assoc. 2006;98(6):834–840.

Waterman

Stanley

Covelli

Hazel

Hong

Brennan

. Living donation decision making: Recipients' concerns and educational needs. Prog Transplant. 2006; 16(1):17–23.

10.

Conrad

Murray

. The psychosocial meanings of living related kidney organ donation: Recipient and donor perspectives—literature review. ANNA J. 1999;26(5):485–490.

11.

Eisendrath

Guttmann

Murray

. Psychologic considerations in the selection of kidney transplant donors. Surg Gynecol Obstet. 1969;129(2):243–248.

12.

Reimer

Rensing

Haasen

Philipp

Pietruck

Franke

. The impact of living-related kidney transplantation on the donor's life. Transplantation. 2006;81(9):1268–1273.

13.

Corley

Elswick

Sargeant

. Attitude, self-image, and quality of life of living kidney donors. Nephrol Nurs J. 2000;27(1):43–50; discussion 1–2.

14.

Lunsford

Shilling

Chavin

. Racial differences in the living kidney donation experience and implications for education. Prog Transplant. 2007;17(3):234–240.

15.

Karrfelt

Berg

Lindblad

. To be or not to be a living donor: Questionnaire to parents of children who have undergone renal transplantation. Transplantation. 1998;65(7):915–918.

16.

Rudow

Chariton

Sanchez

Chang

Serur

Brown

Jr.

Kidney and liver living donors: A comparison of experiences. Prog Transplant. 2005;15(2):185–191.

17.

Stothers

Gourlay

Liu

. Attitudes and predictive factors for live kidney donation: A comparison of live kidney donors versus nondonors. Kidney Int. 2005;67(3):1105–1111.

18.

Burroughs

Waterman

Hong

. One organ donation, three perspectives: Experiences of donors, recipients, and third parties with living kidney donation. Prog Transplant. 2003;13(2):142–150.

19.

Fehrman-Ekholm

Brink

Ericsson

Elinder

Duner

Lundgren

. Kidney donors don't regret: Follow-up of 370 donors in Stockholm since 1964. Transplantation. 2000;69(10):2067–2071.

20.

Prochaska

DiClemente

. Stages and processes of self-change of smoking: Toward an integrative model of change. J Consult Clin Psychol. 1983;51(3):390–395.

21.

Szczepanik

. Assessment and selection considerations: ESRD patient and family education materials and media. Adv Renal Replace Ther. 1995;2(3):207–216.

22.

Durkalski

Palesch

Lipsitz

Rust

. Analysis of clustered matched-pair data. Stat Med. 2003;22(15):2417–2428.

23.

Kleinbaum

Klein

. Logistic regression for correlated data: GEE. In: Logistic Regression: A Self-learning Text. 2nd ed. New York, NY: Springer; 2002:327–375.

24.

Meier-Kriesche

Kaplan

. Waiting time on dialysis as the strongest modifiable risk factor for renal transplant outcomes: A paired donor kidney analysis. Transplantation. 2002;74(10):1377–1381.

25.

Mange

Joffe

Feldman

. Effect of the use or nonuse of long-term dialysis on the subsequent survival of renal transplants from living donors. N Engl J Med. 2001;344(10):726–731.

26.

Gordon

. “They don't have to suffer for me”: Why dialysis patients refuse offers of living donor kidneys. Med Anthropol Q. 2001;15(2):245–267.

27.

Rodrigue

Cornell

Lin

Kaplan

Howard

. Increasing live donor kidney transplantation: A randomized controlled trial of a home-based educational intervention. Am J Transplant. 2007;7(2):394–401.

28.

Mange

Joffe

Feldman

. Dialysis prior to living donor kidney transplantation and rates of acute rejection. Nephrol Dial Transplant. 2003;18(1):172–177.