Study: Social demographics, insurance influence interest in living donor transplants
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Key takeaways:
- Patients on dialysis covered by either Medicare or Medicaid were less likely to be interested in living-related donation.
- Black patients were least likely to pursue living organ donation.
PHILADELPHIA — Social demographics and insurance type are influential factors in efforts to increase interest in living kidney donation among patients on dialysis, researchers said at ASN Kidney Week.
“While living donor kidney transplants offer better patient and graft survival compared to deceased donor kidney transplants, only 23% of all kidney transplants in 2022 were from a living donor,” Adam Walker, PhD, and colleagues from DaVita Clinical Research wrote in a poster presentation. “To provide insight into potential barriers to living donation, we quantified the associations of interest in, and pursuit of, living donor transplant with geographic, demographic and socioeconomic factors among end-stage kidney disease patients.”
The researchers completed a retrospective study of 151,656 adults on dialysis who had indicated they were interested in a kidney transplant. Walker and colleagues used publicly available data sources to classify socioeconomic status of patients in the study group.
“Outcomes considered were interest in living donation and separately, pursuit of living donor transplant,” Walker and colleagues wrote. “Associations between patient characteristics and outcomes were quantified with odds ratios and 95% confidence intervals derived from multivariate logistic regression models assuming a binomial distribution.”
Among the 59,893 patients in whom interest in a transplant was recorded, 11,675 indicated they were interested in living donor transplant. “Among those interested, 7,376 (63.2%) reported having pursued a living donation,” Walker and colleagues wrote. Factors that were associated with interest in living donation included a patient’s age at dialysis start, race/ethnicity, sex, diabetes status, insurance type at dialysis start, kidney education course attendance and poverty level, they reported.
Among the factors associated with a pursuit by patients of a living donation, age at dialysis start, race/ethnicity and insurance type at dialysis start were influential, the researchers wrote. “Both interest and pursuit of living donation varied by state, but there were no obvious regional trends observed,” Walker and colleagues wrote.
Steven M. Brunelli, MD, MSCE, vice president of health analytics and insights at DaVita Clinical Research and a co-author of the poster, told Healio that sociodemographics played a role in access to education about living-related donation. “What we found was that less than one in five patients on dialysis expressed even a willingness to pursue living-related donation,” Brunelli said. “That was a surprising number when you consider all the advantages to the patient. When we saw that low interest, we wanted to look at some of the factors that influenced that view.
“We were surprised and concerned when we saw our patients of color were less likely to be interested in pursuing living donation.”
Brunelli said there was also a strong correlation with the type of insurance a patient had for coverage of their kidney disease. “Patients on government insurance, like Medicare and Medicaid, were less likely to be interested in living-related donation. That opens opportunities to ensure that patients in these insurance programs have the education they need to make choices about whether living donation will benefit them.
“Right now, living donor transplant is the most immediate way to expand the access to transplantation,” Brunelli said. “Yet the rate of living donor transplants has been falling for at least a decade. In this study, we wanted to find out how much of that had to do with patient interest and willingness to pursue that pathway and how much was influenced by barriers to the process itself.”
“We identified subgroups of patients who could potentially benefit from additional education regarding living donor transplant,” Walker and colleagues wrote. “This information may be useful in the design of interventions to increase living donor kidney transplantation rates.”
Reference:
Walker A, et al. Sociodemographic barriers to interest and pursuit of living donation among ESKD patients. Presented at: ASN Kidney Week; Nov. 1-5, 2023; Philadelphia.
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