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Karydis N, Maroulis I. Changing landscape in living kidney donation in Greece. World J Transplant 2023; 13:28-35. [PMID: 36908308 PMCID: PMC9993187 DOI: 10.5500/wjt.v13.i2.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 01/05/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
Patients with end-stage renal disease in Greece are facing long waiting times to receive a kidney transplant from a deceased donor. Living kidney donation offers a valuable alternative that provides optimal outcomes and significantly expands the donor pool but still remains relatively underutilised. Developments around the world in the field of kidney transplantation mandate a change in current practice to include additional options for living donation through paired exchange, antibody-incompatible transplantation and other strategies, following careful consideration of the cultural and ethical factors involved in these complex clinical decisions. An increase in living donation rates may be achieved in several ways, including targeted campaigning to overcome potential barriers. Educating clinicians on transplantation will prove as equally important as informing patients and prospective donors but requires training and resources. Adoption of established practices and implementation of new strategies must be tailored to the needs of the Greek donor and recipient population. Local beliefs about donation, perception of associated risk and other social characteristics must be considered in the design of future strategies. Facilitating living donation in a safe environment with appropriate donor and recipient education will form the solid foundation of a new era of kidney transplantation in Greece.
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Affiliation(s)
- Nikolaos Karydis
- Department of General Surgery and Transplantation, University of Patras, Patras 26504, Greece
| | - Ioannis Maroulis
- Department of General Surgery, University of Patras, Patras 26504, Greece
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Lagging E, Larsson K, Wadström J, Krekula LG, Tibell A. Potential living kidney donors' positive experiences of an information letter from healthcare: a descriptive qualitative study. BMC Nephrol 2022; 23:332. [PMID: 36242025 PMCID: PMC9569060 DOI: 10.1186/s12882-022-02959-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Patients who need a live donor kidney transplant (LDKT) must often ask potential donors (PLDs) themselves. This is a difficult task and healthcare could unburden them by making this first contact, ensuring also that PLDs receive correct information. We investigated how PLDs experience receiving a letter from healthcare about LDKT, live kidney donation, and inviting them to meet with professionals to get more information. Methods The letter (LD-letter) was sent to a cohort of 46 individuals, from which a purposeful sample of 15 were interviewed using a semi-structured guide covering their experience of the letter, views on being approached by healthcare, and opinions on style and content. Interviews were analyzed using conventional inductive analysis. Results We identified three categories of experiences: Category (1) Reflections on receiving the letter, contains three subcategories relating to how the letter did not induce pressure to donate, did not affect the PLD’s relationship with the patient with kidney disease, and made the letter-receiver feel important in the transplant process; Category (2) The letter creates clarification and trust, also contains three subcategories, relating to how it clarified the voluntariness of donation and neutrality of healthcare providers with respect to the PLD’s decision, elucidated the patient with kidney disease’s current stage of disease (where transplantation was approaching), and unburdened patients from the responsibility of contacting PLDs on their own; Category (3) Opinions and suggestions about the letter and further communication, with four subcategories, relating to preference of a letter as the first step for communication about LDKT, suggestions on style and content, views on following up the letter, and how open meetings about LDKT were an important information source. Furthermore, 80% of the interviewees found the letter’s information comprehensive, 67% found it easy to read and respectful, and 86% rated it as good or very good. Conclusion Potential donors prefer and recommend a letter as the first step for communication regarding LD. The LD-letter unburdens patients from the task of asking PLDs and stresses the voluntariness of donation, does not leave PLDs feeling coerced or lead to negative effects in their relationship with the patient. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-022-02959-5.
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Affiliation(s)
- Eva Lagging
- Center for Health Care Ethics, LIME, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Perioperative Medicine and Intensive Care, Regional Donation Center Stockholm-Gotland, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden.
| | - Kjerstin Larsson
- Department of Public Health and Caring Sciences, Health equity and working life, Uppsala University, 752 37, Uppsala, Sweden
| | - Jonas Wadström
- Department of Transplantation Surgery, Karolinska University Hospital, 141 86, Huddinge, Stockholm, Sweden
| | - Linda Gyllström Krekula
- Center for Health Care Ethics, LIME, Karolinska Institutet, 171 77, Stockholm, Sweden.,Perioperative Medicine and Intensive Care, Regional Donation Center Stockholm-Gotland, Karolinska University Hospital, 171 76, Solna, Stockholm, Sweden
| | - Annika Tibell
- Center for Health Care Ethics, LIME, Karolinska Institutet, 171 77, Stockholm, Sweden.,Department of Research, Education and Innovation, Karolinska University Hospital, 171 76, Stockholm, Sweden
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Killian AC, Carter AJ, Reed RD, Shelton BA, Qu H, McLeod MC, Orandi BJ, Cannon RM, Anderson D, MacLennan PA, Kumar V, Hanaway M, Locke JE. Greater community vulnerability is associated with poor living donor navigator program fidelity. Surgery 2022; 172:997-1004. [PMID: 35831221 PMCID: PMC9633042 DOI: 10.1016/j.surg.2022.04.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/19/2022] [Accepted: 04/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Community-level factors contribute to living donor kidney transplantation disparities but may also influence the interventions aimed to mitigate these disparities. The Living Donor Navigator Program was designed to separate the advocacy role from the patient in need of transplantation-friends/family are encouraged to participate as the patients' advocates to identify living donors, though some of the patients participate alone as self-advocates. Self-advocates have a lower living donor kidney transplantation likelihood compared to the patients with an advocate. We sought to evaluate the relationship between the patients' community-level vulnerability and living donor navigator self-advocacy as a surrogate for program fidelity. METHODS This single-center, retrospective study included 110 Living Donor Navigator participants (April 2017-June 2019). Program fidelity was assessed using the participants' advocacy status. Measures of community vulnerability were obtained from the Centers for Disease Control and Prevention Social Vulnerability Index. Modified Poisson regression was used to evaluate the association between community-level vulnerability and living donor navigator self-advocacy. RESULTS Of the 110 participants, 19% (n = 21) were self-advocates. For every 10% increase in community-level vulnerability, patients had 17% higher risk of self-advocacy (adjusted relative risk 1.17, 95% confidence interval: 1.03-1.32, P = .01). Living in areas with greater unemployment (adjusted relative risk: 1.18, 95% confidence interval: 1.04-1.33, P = .01), single-parent households (adjusted relative risk: 1.23, 95% confidence interval: 1.06-1.42, P = .006), minority population (adjusted relative risk: 1.30, 95% confidence interval: 1.04-1.55, P = .02), or no-vehicle households (adjusted relative risk: 1.17, 95% confidence interval: 1.02-1.35, P = .02) were associated with increased risk of self-advocacy. CONCLUSION Having a greater community-level vulnerability was associated with poor Living Donor Navigator Program fidelity. The potential barriers identified using the Social Vulnerability Index may direct resource allocation and program refinement to optimize program fidelity and efficacy for all participants.
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Affiliation(s)
- A Cozette Killian
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL. https://twitter.com/CozetteKale
| | - Alexis J Carter
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL. https://twitter.com/carteraj21
| | - Rhiannon D Reed
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL. https://twitter.com/rhiruns
| | - Brittany A Shelton
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Haiyan Qu
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - M Chandler McLeod
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Babak J Orandi
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Robert M Cannon
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Douglas Anderson
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Paul A MacLennan
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Vineeta Kumar
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Michael Hanaway
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL
| | - Jayme E Locke
- University of Alabama Comprehensive Transplant Institute, Birmingham, AL.
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D'Cunha H, Partin M, Kurschner S, Chu S, Bruin M, McKinney W, Hart A. Journey to Transplant: Developing a social support network counselling intervention to improve kidney transplantation. Health Expect 2021; 25:648-658. [PMID: 34951091 PMCID: PMC8957747 DOI: 10.1111/hex.13412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 11/10/2021] [Accepted: 11/16/2021] [Indexed: 11/28/2022] Open
Abstract
Context Kidney transplant is superior to dialysis for the treatment of end‐stage kidney disease, but accessing transplant requires high patient engagement to overcome barriers. We sought to develop an educational counselling intervention for patients along with their social support networks to help patients access the waiting list. Methods Utilizing an Intervention Mapping approach, we established a conceptual framework to develop a behavioural intervention that can be reproduced across kidney transplant centres. The approach includes needs assessment, identifying behavioural determinants and process objectives and integrating targeted behavioural change theory. Results The Intervention Mapping process resulted in the development of a group counselling session, titled Journey to Transplant (JtT). This intervention was designed for kidney transplant candidates along with members of their social support networks and guided by a transplant healthcare professional. The session begins with standardized educational information to improve knowledge and normalize emotional barriers to transplant. This education is followed by a tailored counselling intervention, including the presentation of the individual patient's calculated likely outcomes on the kidney transplant waiting list. Finally, JtT incorporates patient and support network goal setting to address the specific barriers for that patient in accessing kidney transplantation. Conclusion A systematic Intervention Mapping approach to develop the JtT intervention helps ensure the intervention is efficacious, acceptable and feasible for transplant centres to implement. JtT engages the patient's social support network, targeting known barriers to transplant and utilizing established behaviour change theory to motivate concrete actions to improve the likelihood of kidney transplantation. Patient or Public Contribution This study includes a patient and family advisory committee comprised of kidney transplant candidates and their family members to guide the final language and content of the intervention guide, and the conduct of the implementation and pilot testing of the intervention. However, patients and family members were not involved in the intervention mapping development process itself described in this manuscript, which was informed by focus group data from patient and family study participants.
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Affiliation(s)
- Hannah D'Cunha
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.,Des Moines University College of Osteopathic Medicine, Des Moines, Iowa, USA
| | - Melissa Partin
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.,Department of Medicine, Medical School, University of Minnesota (UMN), Minneapolis, Minnesota, USA
| | - Sophie Kurschner
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA
| | - Sauman Chu
- College of Design, University of Minnesota (UMN), Minneapolis, Minnesota, USA
| | - Marilyn Bruin
- College of Design, University of Minnesota (UMN), Minneapolis, Minnesota, USA
| | - Warren McKinney
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.,Department of Medicine, Medical School, University of Minnesota (UMN), Minneapolis, Minnesota, USA
| | - Allyson Hart
- Chronic Disease Research Group, Hennepin Healthcare Research Institute, Minneapolis, Minnesota, USA.,Department of Medicine, Medical School, University of Minnesota (UMN), Minneapolis, Minnesota, USA.,Division of Nephrology, Department of Medicine, Hennepin Healthcare, Minneapolis, Minnesota, USA
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Carter AJ, Reed RD, Kale AC, Qu H, Kumar V, Hanaway MJ, Cannon RM, Locke JE. Impact of Social Vulnerability on Access to Educational Programming Designed to Enhance Living Donation. Prog Transplant 2021; 31:305-313. [PMID: 34713750 DOI: 10.1177/15269248211046014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Transplant candidate participation in the Living Donor Navigator Program is associated with an increased likelihood of achieving living donor kidney transplantation; yet not every transplant candidate participates in navigator programming. RESEARCH QUESTION We sought to assess interest and ability to participate in the Living Donor Navigator Program by the degree of social vulnerability. DESIGN Eighty-two adult kidney-only candidates initiating evaluation at our center provided Likert-scaled responses to survey questions on interest and ability to participate in the Living Donor Navigator Program. Surveys were linked at the participant-level to the Centers for Disease Control and Prevention Social Vulnerability Index and county health rankings and overall social vulnerability and subthemes, individual barriers, telehealth capabilities/ knowledge, interest, and ability to participate were assessed utilizing nonparametric Wilcoxon ranks sums tests, chi-square, and Fisher's exact tests. RESULTS Participants indicating distance as a barrier to participation in navigator programming lived approximately 82 miles farther from our center. Disinterested participants lived in areas with the highest social vulnerability, higher physical inactivity rates, lower college education rates, and higher uninsurance (lack of insurance) and unemployment rates. Similarly, participants without a computer, who never heard of telehealth, and who were not encouraged to participate in telehealth resided in areas of highest social vulnerability. CONCLUSION These data suggest geography combined with being from under-resourced areas with high social vulnerability was negatively associated with health care engagement. Geography and poverty may be surrogates for lower health literacy and fewer health care interactions.
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Affiliation(s)
- Alexis J Carter
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | - Rhiannon D Reed
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | - A Cozette Kale
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | - Haiyan Qu
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | - Vineeta Kumar
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | - Michael J Hanaway
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | - Robert M Cannon
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | - Jayme E Locke
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
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Sieverdes JC, Mueller M, Nemeth LS, Patel S, Baliga PK, Treiber FA. A distance-based living donor kidney education program for Black wait-list candidates: A feasibility randomized trial. Clin Transplant 2021; 35:e14426. [PMID: 34269480 PMCID: PMC9888645 DOI: 10.1111/ctr.14426] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 05/25/2021] [Accepted: 06/12/2021] [Indexed: 02/02/2023]
Abstract
Addressing racial disparities in living donor kidney transplants (LDKT) among Black patients warrants innovative programs to improve living donation rates. The Living Organ Video Educated Donors (LOVED) program is a 2-arm, culturally-tailored, distance-based, randomized controlled feasibility trial. The group-based, 8-week program used peer-navigator led video chat sessions and web-app video education for Black kidney waitlisted patients from United States southeastern state. Primary feasibility results for LOVED (n = 24) and usual care (n = 24) arms included LOVED program tolerability (i.e., 95.8% retention), program fidelity (i.e., 78.9% video education adherence and 72.1% video chat adherence). LDKT attitudinal and knowledge results favored the LOVED group where a statistically significant effect was reported over 6-months for willingness to approach strangers (estimate ± SE: -1.0 ± .55, F(1, 45.3) = 7.5, P = .009) and self-efficacy to advocate for a LDKT -.81 ± .31, F(1, 45.9) = 15.2, P < .001. Estimates were improved but not statistically significant for willingness to approach family and friends, LDKT knowledge and concerns for living donors (all P's > .088). Secondary measures at 6 months showed an increase in calls for LOVED compared to usual care (P = .008) though no differences were found for transplant center evaluations or LDKTs. Findings imply that LOVED increased screening calls and attitudes to approach potential donors but feasibility outcomes found program materials require modification to increase adherence.
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Affiliation(s)
- John C. Sieverdes
- College of Charleston, Department of Health and Human Performance, 24 George Street, Charleston, SC 29425-1600,Medical University of South Carolina, College of Medicine, 96 Jonathan Lucas St. Charleston, SC 29425-1600, USA
| | - Martina Mueller
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St. Charleston, SC 29425-1600, USA
| | - Lynne S. Nemeth
- Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St. Charleston, SC 29425-1600, USA
| | - Sachin Patel
- Medical University of South Carolina, College of Medicine, 96 Jonathan Lucas St. Charleston, SC 29425-1600, USA,Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St. Charleston, SC 29425-1600, USA
| | - Prabhakar K. Baliga
- Medical University of South Carolina, College of Medicine, 96 Jonathan Lucas St. Charleston, SC 29425-1600, USA
| | - Frank A. Treiber
- Medical University of South Carolina, College of Medicine, 96 Jonathan Lucas St. Charleston, SC 29425-1600, USA,Medical University of South Carolina, College of Nursing, 99 Jonathan Lucas St. Charleston, SC 29425-1600, USA
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Acceptability of a Mobile-Health Living Kidney Donor Advocacy Program for Black Wait-Listed Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168239. [PMID: 34443991 PMCID: PMC8393864 DOI: 10.3390/ijerph18168239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/24/2021] [Accepted: 07/27/2021] [Indexed: 11/16/2022]
Abstract
Marked racial disparities exist in rates of living donor kidney transplantation (LDKT). The Living Organ Video Educated Donors (LOVED) program is a distance-based, mobile health program designed to help Black kidney transplant wait-list patients advocate for a living donor. This study reported on the acceptability outcomes to aid in future refinements. Participants were randomized to LOVED (n = 24, mean age = 50.9 SD (9.2) years), male = 50%) and usual care groups (n = 24 (mean age 47.9 SD (10.0), male 50%). Four LOVED groups completed an eight-week intervention that consisted of six online video education modules and eight group video chat sessions led by a Black navigator. Qualitative analysis from post-study focus groups resulted in six themes: (1) video chat sessions provided essential support and encouragement, (2) videos motivated and made participants more knowledgeable, (3) connectivity with tablets was acceptable in most areas, (4) material was culturally sensitive, (5) participation was overall a positive experience and (6) participants were more willing to ask for a kidney now. The video chat sessions were pertinent in participant satisfaction, though technology concerns limited program implementation. Results showed that the LOVED program was acceptable to engage minorities in health behavior changes for living donor advocacy but barriers exist that require future refinement.
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Reed RD, Killian AC, Mustian MN, Hendricks DH, Baldwin KN, Kumar V, Dionne-Odom JN, Saag K, Hites L, Ivankova NV, Locke JE. The Living Donor Navigator Program Provides Support Tools for Caregivers. Prog Transplant 2020; 31:55-61. [PMID: 33353498 DOI: 10.1177/1526924820978598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The Living Donor Navigator (LDN) program is one of several initiatives designed to help transplant candidates identify living donors with the help of a friend or family member advocate to speak on their behalf. More than half of advocates in the LDN program were the spouse or parent of the candidate and served in a caregiving role. Caregivers for patients awaiting transplantation have reported poorer quality of life than the general population, suggesting more support is needed for this vulnerable group. The purpose of this study was to understand whether the LDN program met the needs of advocates who were also caregivers for the transplant candidate. METHODS We performed a supplementary secondary qualitative analysis of a parent study conducted December 2017-January 2018 with 9 advocates who participated in the LDN program. Transcripts were reanalyzed from focus group discussions, concentrating on comments about caregiving or made by caregivers. Using manual coding and reflexive thematic analysis, we identified broad codes and major themes. FINDINGS Our re-analysis revealed one theme overlapping with our previous analysis (Support) and 2 new themes specific to caregiver advocates: Quality of Life and Fear. Caregivers agreed that the LDN program equipped them with tools to address these areas and best serve their simultaneous caregiver/advocate roles. DISCUSSION These analyses demonstrated that those who served as advocate and caregiver derived a benefit from the LDN program but had distinct needs from other advocates. These findings can inform continued refinement of the program and expansion to support needs of caregiver.
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Affiliation(s)
- Rhiannon D Reed
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | - A Cozette Killian
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | - Margaux N Mustian
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | - Daagye H Hendricks
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | - Kimberly N Baldwin
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | - Vineeta Kumar
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
| | | | - Kenneth Saag
- 9968University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Lisle Hites
- 37364University of Alabama College of Community Health Sciences, Tuscaloosa, AL, USA
| | - Natalia V Ivankova
- 9968University of Alabama at Birmingham School of Nursing, Birmingham, AL, USA.,9968University of Alabama at Birmingham School of Health Professions, Birmingham, AL, USA
| | - Jayme E Locke
- 9968University of Alabama at Birmingham Comprehensive Transplant Institute, Birmingham, AL, USA
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Killian AC, Reed RD, Carter A, McLeod MC, Shelton BA, Kumar V, Qu H, MacLennan PA, Orandi BJ, Cannon RM, Anderson D, Hanaway MJ, Locke JE. Self-advocacy is associated with lower likelihood of living donor kidney transplantation. Am J Surg 2020; 222:36-41. [PMID: 33413873 DOI: 10.1016/j.amjsurg.2020.12.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 12/08/2020] [Accepted: 12/20/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Living Donor Navigator (LDN) Program pairs kidney transplant candidates (TC) with a friend or family member for advocacy training to help identify donors and achieve living donor kidney transplantation (LDKT). However, some TCs participate alone as self-advocates. METHODS In this retrospective cohort study of TCs in the LDN program (04/2017-06/2019), we evaluated the likelihood of LDKT using Cox proportional hazards regression and rate of donor screenings using ordered events conditional models by advocate type. RESULTS Self-advocates (25/127) had lower likelihood of LDKT compared to patients with an advocate (adjusted hazard ratio (aHR): 0.22, 95% confidence interval (CI): 0.03-1.66, p = 0.14). After LDN enrollment, rate of donor screenings increased 2.5-fold for self-advocates (aHR: 2.48, 95%CI: 1.26-4.90, p = 0.009) and 3.4-fold for TCs with an advocate (aHR: 3.39, 95%CI: 2.20-5.24, p < 0.0001). CONCLUSIONS Advocacy training was beneficial for self-advocates, but having an independent advocate may increase the likelihood of LDKT.
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Affiliation(s)
- A Cozette Killian
- University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA.
| | - Rhiannon D Reed
- University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA.
| | - Alexis Carter
- University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA.
| | - M Chandler McLeod
- University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA.
| | - Brittany A Shelton
- University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA.
| | - Vineeta Kumar
- University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA.
| | - Haiyan Qu
- University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA.
| | - Paul A MacLennan
- University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA.
| | - Babak J Orandi
- University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA.
| | - Robert M Cannon
- University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA.
| | - Douglas Anderson
- University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA.
| | - Michael J Hanaway
- University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA.
| | - Jayme E Locke
- University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA.
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Is There Decreasing Public Interest in Renal Transplantation? A Google Trends TM Analysis. J Clin Med 2020; 9:jcm9041048. [PMID: 32272783 PMCID: PMC7231300 DOI: 10.3390/jcm9041048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Renal transplantation is the preferred form of renal replacement therapy for the majority of patients with end stage renal disease (ESRD). The Internet is a key tool for people seeking healthcare-related information. This current work explored the interest in kidney transplantation based on Internet search queries using Google TrendsTM. DESIGN, SETTING, PARTICIPANTS, AND MEASUREMENTS We performed a Google TrendsTM search with the search term "kidney transplantation" between 2004 (year of inception) and 2018. We retrieved and analyzed data on the worldwide trend as well as data from the United Network for Organ Sharing (UNOS), the Organización Nacional de Trasplantes (ONT), the Eurotransplant area, and the National Health Service (NHS) Transplant Register. Google TrendsTM indices were investigated and compared to the numbers of performed kidney transplants, which were extracted from the respective official websites of UNOS, ONT, Eurotransplant, and the NHS. RESULTS During an investigational period of 15 years, there was a significant decrease of the worldwide Google TrendsTM index from 76.3 to 25.4, corresponding to an absolute reduction of -50.9% and a relative reduction by -66.7%. The trend was even more pronounced for the UNOS area (-75.2%), while in the same time period the number of transplanted kidneys in the UNOS area increased by 21.9%. Events of public interest had an impact on the search queries in the year of occurrence, as shown by an increase in the Google TrendsTM index by 39.2% in the year 2005 in Austria when a person of public interest received his second live donor kidney transplant. CONCLUSIONS This study indicates a decreased public interest in kidney transplantation. There is a clear need to raise public awareness, since transplantation represents the best form of renal replacement therapy for patients with ESRD. Information should be provided on social media, with a special focus on readability and equitable access, as well as on web pages.
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