Although Black individuals suffer from kidney failure at a markedly increased rate compared with White individuals in the US, Black patients have reduced access to kidney transplants and are significantly underrepresented on kidney transplant waitlists. New research from the Journal of the American College of Surgeons shows, however, that reducing structural barriers in access to kidney transplants can reduce inequity in tandem.
In the study, healthcare workers at the Medical University of South Carolina (MUSC) in Charleston were able to significantly improve access to kidney transplants for Black patients by streamlining and standardizing the evaluation process, improving patient and staff education, and expanding the use of virtual visits and organs from high-risk donors.
“Interventions to reduce structural barriers in access to transplants significantly increase the proportion of African Americans that can complete a transplant evaluation, be added to the transplant waitlist, and eventually receive a transplant,” said lead author and transplant surgeon Derek A. DuBay, MD, MSPH.
Despite Black patients being more likely than White patients to be referred for evaluation for kidney transplants, Black patients were not getting in for evaluations and addition to the waitlist. In a 5-year retrospective study of end-stage kidney disease patient data at MUSC, Dr. DuBay’s research team measured the impact of quality improvement interventions intended to reduce key barriers to evaluation once the patient was referred for transplant. Interventions included uniform protocols to standardize the evaluation process, increased use of virtual visits to reduce in-person time required with a physician, and offering an educational program for dialysis center staff and patients addressed misconceptions and misunderstandings about the kidney transplant process.
The authors found that these interventions significantly reduced the inequities related to initiated evaluations, completed evaluations, and waitlist additions, and increased access to transplants without affecting outcomes.