Identification of Strategies to Facilitate Organ Donation among African Americans using the Nominal Group Technique : Clinical Journal of the American Society of Nephrology

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Identification of Strategies to Facilitate Organ Donation among African Americans using the Nominal Group Technique

Locke, Jayme E.*; Qu, Haiyan; Shewchuk, Richard; Mannon, Roslyn B.*; Gaston, Robert*; Segev, Dorry L.; Mannon, Elinor C.§; Martin, Michelle Y.

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Clinical Journal of the American Society of Nephrology 10(2):p 286-293, February 2015. | DOI: 10.2215/CJN.05770614
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Over 100,000 patients are currently waiting for a deceased donor kidney transplant, but each year, only 11,000 patients receive a transplant (1). Many waitlisted patients (5%–15%) die before receiving a transplant (1). As a result, the topic of organ donation has taken center stage as an important public health issue, and there is an increased emphasis on living kidney donation (2,3). Against this backdrop is the disproportionate number of African Americans affected by ESRD in need of transplantation; however, African Americans are less likely than other ethnic groups to receive a kidney (48).

Data have shown that individuals awaiting transplant have a better chance of finding a compatible kidney when there are larger numbers of donors from their same ethnic/racial background, with racial concordance between donor-recipient pairs >95% (9). Surveys assessing attitudes toward donation have shown that African Americans are 20% less likely to express a willingness to donate their own organs compared with Caucasian Americans (10,11). Not surprisingly, African Americans comprise 34% of waitlisted patients but only 11% of recipients of living donor kidney transplants (8,12).

Prior studies have shown mistrust of the medical community and religious/cultural beliefs to be major predisposing factors for the lower organ donation rates among African Americans (10,1316). Given the prominent role of the church in shaping African-American community life, some have suggested church-based interventions to overcome these concerns (17,18). Studies incorporating organizational constructs known to influence beliefs and priorities, such as the church, are needed to identify factors that may facilitate the willingness of African Americans to become organ donors, particularly living kidney donors. Herein, we report findings from a formative research study that uses the nominal group technique (NGT) to identify and prioritize strategies for promoting organ donation among church-attending African Americans.

Materials and Methods

Ethical Approval and Participant Reimbursement

Approval from the Institutional Review Board of the University of Alabama at Birmingham was secured before proceeding with the research. Informed consent was received from each participant. An honorarium of United States $25 was paid to participants. The research activities being reported are consistent with the Principles of the Declaration of Istanbul as outlined in the “Declaration of Istanbul on Organ Trafficking and Transplant Tourism.”


The NGT is a well established, highly structured, multistep facilitated group meeting that uses informant panels to elicit and prioritize responses to a specific question (1923). To be an effective data collection activity, the NGT structured meetings include (1) silent written generation of responses to a single study question, (2) round robin presentation and recording of responses, (3) nonevaluative discussion of responses for clarification, and (4) anonymous voting on response importance (24,25). The initial tabulation of the prioritized responses is reviewed with participants for task completion and to obtain additional response clarity. The NGT meetings are structured to effectively minimize the process loss that occurs when group participants directly interact, which often occurs with brainstorming and focus groups (26). This structure promotes even rates of participation and equally weights the input from all participants, and as such, the anonymously ranked responses provide a valid reflection of the collective views held by group participants (27).

Formulation of the NGT Question

The success of the NGT as a formative research method is dependent on designing a question that both clarifies the objective of the meeting and elicits the desired responses. To accomplish this task, the research team prepared several candidate questions intended to elicit facilitative strategies for increasing the willingness of African Americans to become organ donors. We elected to focus on facilitative strategies as opposed to barriers, because a thorough review of the literature indicated this area to be an area in need of more focused attention. The candidate questions were evaluated through an informal cognitive interviewing process, which involved a panel of seven individuals (not enrolled in the study), to determine how the questions were understood and whether they elicited the information as intended. Each candidate question was assessed for level of (1) accuracy or the level of abstraction of responses and (2) clarity or the scope of responses. The question that elicited the greatest accuracy and clarity in terms of responses was chosen and used in the NGT panel meetings: “What would make it easier for people to decide to become organ donors?”


A brief questionnaire was constructed to assess willingness to donate one’s organs after death and willingness to be a living kidney donor. Each question was associated with a four-point Likert scale ranging from strongly disagree to disagree to agree to strongly agree. The questionnaire also contained basic demographic questions and was administered at the beginning of the NGT session.

Participant Selection and Recruitment

Adult (≥19 years old) church-attending African Americans in the local Birmingham area were recruited to participate in the NGT meetings. To the extent possible, we sought to maximize participation from individuals representing varied faith-based denominations. Three NGT panels consisted of churchgoing community members, and each of the panels represented a different faith-based denomination. Individual participants were recruited from three distinct local African-American churches and contacted directly by research team members by telephone and in-person interactions. The fourth NGT panel consisted of church clergy recruited from local African-American churches. Five distinct faith-based denominations were represented in this final NGT panel.

Panel Participation

Each NGT meeting was structured to promote equal involvement of all participants, with each session lasting approximately 90 minutes. Participants in each meeting group were informed that the purpose of the meeting was to tap into their unique insights, knowledge, and experiences to identify a comprehensive list of varying strategies that may help African Americans in making the decision to become an organ donor. Group members were informed of the ground rules for the meeting and asked to work independently and develop their own lists of concise statements/phrases in response to the NGT question. To help ensure that a wide array of responses would be generated, participants were encouraged to think broadly about the different types of strategies that members of their community would find helpful. Each participant was then given an opportunity to present their responses to the group. To promote open disclosure, increase response volume, and ensure that all participants had an equal opportunity to contribute to the generation of responses, a round robin format was used. This format involved having each participant in turn articulate a single response to the question without providing any rationale, justification, or explanation. The facilitators immediately recorded each response verbatim. The nomination process continued until all responses were exhausted.

Participants from each panel were given an opportunity to briefly discuss the responses (strategies) that they generated for the purposes of clarification (not evaluation) to ensure that every response was understood from a common perspective. During these discussion phases, there was some response elaboration, and a small number of responses were added to the lists.

The final phase of each meeting consisted of a structured prioritization exercise that involved having participants anonymously selecting from the group list what they individually perceived as the three most important strategies that might facilitate increases in organ donation among the African-American community. Participants could select any three strategies from the group list and were not limited to strategies that they themselves nominated. Each participant was then asked to rank each of their three chosen strategies by weighting the strategies from most to least important. To accomplish this task, each participant was given a total of six votes and asked to assign three votes to the strategy that they considered most important, two votes to the second most important strategy, and one vote to the third most important strategy. The individual rank orderings were aggregated across participants to tabulate a group level result, which was then presented to the group for comments. Thus, each individual panel generated a unique set of responses.


Study Population

Twenty-eight church-attending African-American adults enrolled in the study; 21 community participants completed the questionnaire, and 20 participants completed the NGT exercise. Seven clergy participants completed the NGT exercise, and six clergy participants completed the questionnaire. In total, 60.7% of participants were women, with a mean age of 52 (±11) years; 33.3% of community participants and 42.9% of clergy participants reported an income above the median state (Alabama) and federal household income levels, and 71.4% of participants had an education at or above the college level (community=66.6%; clergy=85.8%) (Table1).

Table 1:
Demographic composition of the participant panels

Identified Strategies

Individually, 66.7% (18 of 27) of participants indicated that knowledge about organ donation was the most important facilitator for increasing organ donation rates (living and deceased) among African Americans by awarding their highest weighted vote (three points) to knowledge- or education-based strategies. This was slightly more pronounced among clergy compared with community participants (71.4% versus 65.0%). Among four convened NGT panels, three of four (community: two of three panels; clergy: one of one) panels rated knowledge about organ donation as the most important facilitating factor. Collated NGT group responses that used terms such as knowledge, understand, or telling were defined as knowledge or education based (Table 2).

Table 2:
Specific knowledge- and education-based strategies for facilitating increases in organ donation among African Americans

Community Panel 1—Nondenominational (n=8).

In total, 29 strategies were elicited, and 13 strategies were assigned votes. Five strategies were endorsed as relatively more important than others, accounting for 77% of 48 total available weighted votes (Table 3). Three strategies received 50% more votes than the other identified strategies: (1) provide more information about organ donation, (2) better publicize the need for organ donation, and (3) simplify the organ donation process to make it easier to become an organ donor.

Table 3:
Detailed list of prioritized strategies elicited from nominal group technique participants aimed at facilitating organ donation among the African-American community

Community Panel 2—Baptist Denomination (n=7).

In total, 27 strategies were elicited, and 11 strategies were assigned votes by six participants (one participant elected not to complete the study) (Table 3). Five strategies were endorsed as relatively more important than others, accounting for 80% of 36 total available weighted votes: (1) show more television advertisements and commercials about the need and importance of organ donation, (2) provide potential donors information about what actually is involved, (3) help people recognize that organ donation can help someone in need, (4) provide payment to donors, and (5) help potential donors understand how big the need for organ donation is.

Community Panel 3—Pentecostal Denomination (n=6).

In total, 27 strategies were identified, and 12 strategies were assigned votes. Six strategies were endorsed as relatively more important than others, accounting for 72% of 36 total available weighted votes (Table 3). Two strategies received 50% more votes than the other identified strategies: (1) provide seminars at work or at school to educate and inform people about organ donation and (2) help people to understand that the decision to become an organ donor may help someone to maintain a productive life.

Church Clergy Panel (n=7).

Five faith-based denominations were represented: nondenominational (n=1), Baptist (n=2), Methodist (n=1), Seventh Day Adventist (n=1), and Pentecostal (n=2). In total, 31 strategies were elicited; 14 strategies were assigned votes, and five strategies were endorsed as relatively more important than others, accounting for 64.3% of42 total available weighted votes (Table 3). Two strategies received 50% more votes than the other identified strategies: (1) help people become more knowledgeable about organ donation and (2) help overcome the lack of trust in the medical community.

Willingness to Donate

In total, 29.6% of participants indicated that they disagreed with deceased donation, and 37% of participants indicated that they disagreed with living donation (deceased: eight of 27; living: 10 of 27). Community participants’ reservations about becoming an organ donor were similar for living and deceased donation (disagree: living, 38.1% versus deceased, 33.4%). In contrast, clergy participants were more likely to express reservations about living donation (disagree: living, 33.3% versus deceased, 16.7%) (Table 4).

Table 4:
Assessment of baseline willingness to become an organ donor—deceased or living


In this novel formative research study, African Americans identified knowledge acquisition as the most important factor for facilitating willingness to become an organ donor. Uniquely, participants primarily focused on acquiring knowledge specific to potential donors, such as helping potential donors better understand the donation process and donation-related risks, particularly in the context of a potential living donor’s existing health status. Overall, approximately one third of study participants disagreed with being an organ donor. Moreover, there seemed to be greater opposition to living donation compared with donation after one’s death, and this finding was most pronounced among clergy compared with community participants.

With substantial potential to promote health, partnerships between faith organizations and the health system are not new. In fact, it has been shown that individuals who attend church services regularly are more likely to have continuity with a health provider than those who do not attend (28). Moreover, studies have shown that regular church attendance is linked with improved health and wellbeing, suggesting that regular church attendance is associated with more medical community interactions and improved health-related knowledge (29,30). It follows then that church-attending African Americans may be exposed to more educational opportunities on topics such as organ donation. Recruitment of churchgoing participants afforded us the greatest opportunity to identify facilitating factors that may extend beyond knowledge acquisition. Interestingly, our study found that knowledge acquisition remains a key determinant in the willingness of African Americans to donate. Uniquely, however, the need for knowledge now seems to be centered on donor-related issues, particularly with regard to living kidney donation. Previous studies have correlated low socioeconomic status with lack of knowledge (3133); however, our data indicate that the problem may be more related to information gaps about risks and benefits specific to African-American donors as opposed to lack of understanding of existing data, suggesting a need for refinements to current educational programming on organ donation.

Prior studies have highlighted the importance that knowledge plays in improving deceased organ donation consent rates, but almost universally, these studies have identified lack of knowledge about recipient benefit as the primary motivator (34,35). Although our study suggests that knowledge remains a key determinant in the willingness of African Americans to donate, this investigation has yielded novel findings. Specifically, stakeholders in the African-American community achieved consensus that the key to increasing organ donation is the provision of additional information on donor-related issues, particularly living kidney donation. It is not surprising that African Americans cite lack of knowledge as a deterrent to organ donation. In fact, a 2010 United States consensus conference entitled “Living Kidney Donor Follow-up: State-of-the-Art and Future Direction” concluded that more information is needed on postdonation outcomes, including hypertension and CKD (36). African-American living donors were identified as a leading subgroup in need of focused attention because of poor understanding of donation-related risks.

In addition to these novel findings, our study is the first of its kind in the United States to use the NGT, a technique considered highly valid and widely applicable, to assess willingness to become an organ donor. The NGT is a highly structured formative research tool that minimizes the process loss that occurs when group participants directly interact, allowing robust data collection to occur, despite smaller sample sizes. The use of the NGT allowed us to understand specific needs, preferences, and culture in relation to organ donation willingness among African Americans. Results from this study indicate that a tailored educational program that addresses these factors, particularly donation-related involvement and risks, is needed to facilitate organ donation within the African-American community. These findings will be used as the foundation for a cognitive mapping study and development of a Delphi questionnaire on organ donation, affording the opportunity for more widespread participation, assessment of the generalizability of our findings, and ultimately, development of educational programming.

Although there are strengths associated with NGT-based formative research, we must acknowledge several study limitations. Our study involved only 28 participants, all of whom live in the Deep South and attended church, potentially limiting the validity and generalizability of our findings in the broader United States African-American population. A major goal of our study, however, was to assess willingness to be an organ donor among a subset of African Americans most likely to have been exposed to the medical community on a consistent basis, and therefore, have the greatest likelihood of having discussed organ donation. Prior studies have shown that church-attending individuals have more continuity with the medical community, supporting the decision to limit the study population to church-attending African Americans (28). Moreover, it is well known that the church plays a key role in African-American community life (37). Involvement of key stake holders early during the formative research stages has been shown to be critical for effective educational program development, implementation, and adoption within the priority community (38). In addition, we did not assess the influence of the a priori knowledge of the participants of end stage disease, organ donation, and transplantation on their willingness to donate, and as such, it is possible that the prior experiences of participants may have biased our results. However, recruitment materials and strategies that involved leading phrasing/terminology that may have encouraged only individuals with experience in organ donation and/or transplantation to participate were avoided. Furthermore, the NGT panels comprise a select group of individuals, but our experience suggests that only a few meetings are necessary and usually sufficient to identify a full array of responses to a particular question and achieve idea saturation. (26) Although small sample size is often associated with weak study design, in the context of formative research using the NGT, smaller sample sizes actually enhance and facilitate robust research subject participation and granularity of data collection (38). Specifically, the NGT minimizes normative pressures for conformity prevalent in conventional large-group discussions, hidden agendas, and overt group dynamics, and in so doing, it ensures that minority ideas and opinions are expressed (20,39). Finally, although it is possible that interpretation bias occurred, it is unlikely given that the written verbatim responses of participants were recorded in real time (20,39).

At a population level, African Americans have high rates of ESRD and substantial need for organ donors (particularly living kidney donors), but less access to transplantation (4,5,7,8,40). It is well established that African Americans have significantly lower organ donation rates (12,41,42). Our data suggest that improving knowledge about organ donation, particularly with regard to donor involvement and donation-related risks, may facilitate increases in organ donation among the African-American community. Moreover, our findings suggest that existing educational campaigns may fall short of meeting the information needs of this population and that efforts should be directed to expanding the educational content to balance both risks and benefits to the organ recipient and donor. These data represent the first step in a formative research process designed to identify the most salient facilitating factor for promoting willingness to be an organ donor among the African-American community, and they will serve as the foundation for development of educational interventions focused on improving knowledge of donor-related risks and outcomes.




This work was supported by the Center of Excellence in Comparative Effectiveness Research for Eliminating Disparities (National Center on Minority Health and Health Disparities [NCMHD] Grant 3P60-MD000502) from the National Institutes of Health (NIH) and the Charles Barkley Health Disparities Research Award through the University of Alabama at Birmingham Minority Health and Health Disparities Research Center (NCMHD Grant 5P60-MD000502).

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCMHD or the NIH.

Published online ahead of print. Publication date available at

See related editorial, “Strategies To Facilitate Organ Donation among African Americans,” on pages 177–179.


1. US Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients: Annual Report of the US Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients, 2013. Available at: Accessed January 30, 2014
2. AST/ASTS/NATCO/UNOS Joint Societies Work Group: Evaluation of the living kidney donor—a consensus document from the AST/ASTS/NATCO/UNOS Joint Societies Work Group. Presented at the Joint Societies Work Group of the Joint Societies Steering Committee, September 27–28, 2010, Rockville, MD
3. Leichtman A, Abecassis M, Barr M, Charlton M, Cohen D, Confer D, Cooper M, Danovitch G, Davis C, Delmonico F, Dew MA, Garvey C, Gaston R, Gill J, Gillespie B, Ibrahim H, Jacobs C, Kahn J, Kasiske B, Kim J, Lentine K, Manyalich M, Medina-Pestana J, Merion R, Moxey-Mims M, Odim J, Opelz G, Orlowski J, Rizvi A, Roberts J, Segev D, Sledge T, Steiner R, Taler S, Textor S, Thiel G, Waterman A, Williams E, Wolfe R, Wynn J, Matas AJLiving Kidney Donor Follow-Up Conference Writing Group: Living kidney donor follow-up: state-of-the-art and future directions, conference summary and recommendations. Am J Transplant 11: 2561–2568, 2011
4. Freedman BI, Spray BJ, Tuttle AB, Buckalew VM Jr.: The familial risk of end-stage renal disease in African Americans. Am J Kidney Dis 21: 387–393, 1993
5. Derose SF, Rutkowski MP, Crooks PW, Shi JM, Wang JQ, Kalantar-Zadeh K, Kovesdy CP, Levin NW, Jacobsen SJ: Racial differences in estimated GFR decline, ESRD, and mortality in an integrated health system. Am J Kidney Dis 62: 236–244, 2013
6. Muntner P, Newsome B, Kramer H, Peralta CA, Kim Y, Jacobs DR Jr., Kiefe CI, Lewis CE: Racial differences in the incidence of chronic kidney disease. Clin J Am Soc Nephrol 7: 101–107, 2012
    7. Tarver-Carr ME, Powe NR, Eberhardt MS, LaVeist TA, Kington RS, Coresh J, Brancati FL: Excess risk of chronic kidney disease among African-American versus white subjects in the United States: A population-based study of potential explanatory factors. J Am Soc Nephrol 13: 2363–2370, 2002
    8. Bratton C, Chavin K, Baliga P: Racial disparities in organ donation and why. Curr Opin Organ Transplant 16: 243–249, 2011
    9. Reeves-Daniel A, Bailey A, Assimos D, Westcott C, Adams PL, Hartmann EL, Rogers J, Farney AC, Stratta RJ, Daniel K, Freedman BI: Donor-recipient relationships in African American vs. Caucasian live kidney donors. Clin Transplant 25: E487–E490, 2011
    10. Minniefield WJ, Yang J, Muti P: Differences in attitudes toward organ donation among African Americans and whites in the United States. J Natl Med Assoc 93: 372–379, 2001
    11. McNamara P, Guadagnoli E, Evanisko MJ, Beasley C, Santiago-Delpin EA, Callender CO, Christiansen E: Correlates of support for organ donation among three ethnic groups. Clin Transplant 13: 45–50, 1999
    12. Health OoM: Organ Donation and African Americans, 2013. Available at: Accessed March 10, 2014
    13. Boulware LE, Ratner LE, Cooper LA, Sosa JA, LaVeist TA, Powe NR: Understanding disparities in donor behavior: Race and gender differences in willingness to donate blood and cadaveric organs. Med Care 40: 85–95, 2002
    14. Brown ER: African American present perceptions of organ donation: A pilot study. ABNF J 23: 29–33, 2012
      15. Minniefield WJ, Muti P: Organ donation survey results of a Buffalo, New York, African-American community. J Natl Med Assoc 94: 979–986, 2002
        16. Siminoff LA, Burant CJ, Ibrahim SA: Racial disparities in preferences and perceptions regarding organ donation. J Gen Intern Med 21: 995–1000, 2006
        17. Arriola K, Robinson DH, Thompson NJ, Perryman JP: Project ACTS: An intervention to increase organ and tissue donation intentions among African Americans. Health Educ Behav 37: 264–274, 2010
        18. Arriola KR, Perryman JP, Doldren MA, Warren CM, Robinson DH: Understanding the role of clergy in African American organ and tissue donation decision-making. Ethn Health 12: 465–482, 2007
        19. Delbecq AL, Van de Gen AH: A group process model for problem identification and program planning. J Appl Behav Sci 7(4): 466–491, 1971
        20. Delbecq AL, Van de Gen AH, Gustafson DH: Group Techniques for Program Planning: A Guide to Nominal Group and Delphi Processes, Glenview, IL, Scott Foresman Company, 1975
        21. Kristofco R, Shewchuk R, Casebeer L, Bellande B, Bennett N: Attributes of an ideal continuing medical education institution identified through nominal group technique. J Contin Educ Health Prof 25: 221–228, 2005
          22. Shewchuk RM, O’Connor SJ, Fine DJ: Building an understanding of the competencies needed for health administration practice. J Healthc Manag 50: 32–47, 2005
            23. Shewchuk RM, Schmidt HJ, Benarous A, Bennett NL, Abdolrasulnia M, Casebeer LL: A standardized approach to assessing physician expectations and perceptions of continuing medical education. J Contin Educ Health Prof 27: 173–182, 2007
            24. Castiglioni A, Shewchuk RM, Willett LL, Heudebert GR, Centor RM: A pilot study using nominal group technique to assess residents’ perceptions of successful attending rounds. J Gen Intern Med 23: 1060–1065, 2008
            25. Elliott T, Shewchuck R: Using the Nominal Group Technique to identify the problems experienced by persons who live with severe physical disability. J Clin Psychol Med Settings 9(2): 65–76, 2002
            26. Ruyter KD: Focus versus nominal group interviews: A comparative analysis. Mark Intell Plann 14(6): 44–50, 1996
            27. Harvey N, Holmes CA: Nominal group technique: An effective method for obtaining group consensus. Int J Nurs Pract 18: 188–194, 2012
            28. King DE, Pearson WS: Religious attendance and continuity of care. Int J Psychiatry Med 33: 377–389, 2003
            29. King DE, Cummings D, Whetstone L: Attendance at religious services and subsequent mental health in midlife women. Int J Psychiatry Med 35: 287–297, 2005
            30. Krause N: Common facets of religion, unique facets of religion, and life satisfaction among older African Americans. J Gerontol B Psychol Sci Soc Sci 59: S109–S117, 2004
            31. Wakefield CE, Watts KJ, Homewood J, Meiser B, Siminoff LA: Attitudes toward organ donation and donor behavior: A review of the international literature. Prog Transplant 20: 380–391, 2010
            32. Boulware LE, Ratner LE, Sosa JA, Cooper LA, LaVeist TA, Powe NR: Determinants of willingness to donate living related and cadaveric organs: Identifying opportunities for intervention. Transplantation 73: 1683–1691, 2002
              33. Gill J, Dong J, Rose C, Johnston O, Landsberg D, Gill J: The effect of race and income on living kidney donation in the United States. J Am Soc Nephrol 24: 1872–1879, 2013
              34. Callender CO, Miles PV: Minority organ donation: the power of an educated community. J Am Coll Surg 210: 708–715, 715–717, 2010
              35. Deedat S, Kenten C, Morgan M: What are effective approaches to increasing rates of organ donor registration among ethnic minority populations: A systematic review. BMJ Open 3: e003453, 2013
              36. Leichtman A, Abecassis M, Barr M, Charlton M, Cohen D, Confer D, Cooper M, Danovitch G, Davis C, Delmonico F, Dew MA, Garvey C, Gaston R, Gill J, Gillespie B, Ibrahim H, Jacobs C, Kahn J, Kasiske B, Kim J, Lentine K, Manyalich M, Medina-Pestana J, Merion R, Moxey-Mims M, Odim J, Opelz G, Orlowski J, Rizvi A, Roberts J, Segev D, Sledge T, Steiner R, Taler S, Textor S, Thiel G, Waterman A, Williams E, Wolfe R, Wynn J, Matas AJLiving Kidney Donor Follow-Up Conference Writing Group: Living kidney donor follow-up: State-of-the-art and future directions, conference summary and recommendations. Am J Transplant 11: 2561–2568, 2011
              37. Taylor RJ, Chatters LM, Jackson JS: Religious and spiritual involvement among older african americans, Caribbean blacks, and non-Hispanic whites: Findings from the national survey of american life. J Gerontol B Psychol Sci Soc Sci 62: S238–S250, 2007
              38. Cantrill JA, Sibbald B, Buetow S: The Delphi and nominal group techniques in health services research. Int J Pharm Pract 4(2): 67–74, 1996
              39. Delp P, Thesen A, Motiwalla J, Seshardi N: Nominal Group Technique, Bloomington, IN, International Development Institute, 1977
              40. Muntner P, Judd SE, McClellan W, Meschia JF, Warnock DG, Howard VJ: Incidence of stroke symptoms among adults with chronic kidney disease: Results from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. Nephrol Dial Transplant 27: 166–173, 2012
              41. Purnell TS, Hall YN, Boulware LE: Understanding and overcoming barriers to living kidney donation among racial and ethnic minorities in the United States. Adv Chronic Kidney Dis 19: 244–251, 2012
              42. Hall EC, James NT, Garonzik Wang JM, Berger JC, Montgomery RA, Dagher NN, Desai NM, Segev DL: Center-level factors and racial disparities in living donor kidney transplantation. Am J Kidney Dis 59: 849–857, 2012

              kidney donation; organ transplant; renal transplantation

              Copyright © 2015 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.