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Enhanced Advocacy and Health Systems Training through Patient Navigation Increases Access to Living Donor Kidney Transplantation

Locke, Jayme E. MD1,*; Reed, Rhiannon D. MPH1; Kumar, Vineeta MD1; Berry, Beverly MA1; Hendricks, Daagye MBA1; Carter, Alexis BS1; Shelton, Brittany A. MPH1; Mustian, Margaux N. MD1; MacLennan, Paul A. PhD1; Qu, Haiyan PhD1; Hannon, Lonnie PhD2; Yates, Clayton PhD2; Hanaway, Michael J. MD1

doi: 10.1097/TP.0000000000002732
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Background: To date, no living donation program has simultaneously addressed the needs of both transplant candidates and living donors by separating the advocacy role from the candidate and improving potential donor comfort with the evaluation process. We hypothesized that development of a novel program designed to promote both advocacy and systems training among transplant candidates and their potential living kidney donors would result in sustained increases in living kidney donor transplantation (LDKT). To this end, we developed and implemented a Living Donor Navigator (LDN) Program at the University of Alabama at Birmingham.

Methods: We included adult patients awaiting kidney-only transplant in a retrospective cohort analysis. Using time varying Cox proportional hazards regression, we explored likelihood of living donor screening and approval by participation in the LDN program.

Results: There were 56 LDN participants and 1,948 non-participants (standard of care). LDN was associated with a 9-fold increased likelihood of living donor screenings (adjusted hazard ratio (aHR): 9.27, 95%CI: 5.97-14.41, p<0.001) and a 7-fold increased likelihood of having an approved living donor (aHR: 7.74, 95%CI: 3.54-16.93, p<0.001) compared to standard of care. Analyses by participant race demonstrated higher likelihood of screened donors and a similar likelihood of having an approved donor among African Americans compared to Caucasians.

Conclusion: These data suggest that both advocacy and systems training are needed to increase actual LDKT rates, and that LDN programs may mitigate existing racial disparities in access to LDKT.

1University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, Alabama

2Tuskegee University Department of Biology and Center for Cancer Research, Tuskegee University, Tuskegee, Alabama

Disclosure: The authors declare no conflicts of interest.

Funding: This work was supported in part by the American Society of Nephrology Foundation Pre-Doctoral Fellowship Award Program (PI: RD Reed) and the UAB AMC 21 Grant Program (PI: JE Locke.

Corresponding Author: Jayme E. Locke MD, MPH, FACS, FAST, 701 19th Street South, LHRB 780, Birmingham, AL 35294, (p) 205-934-2131, (f) 205-934-0320, jlocke@uabmc.edu

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