ACCESS TO TREATMENT AND QUALITY OF LIFE

K. Ladin¹, E. Langnas², J.R. Rodrigue², M. Pavlakis², D. Mandelbrot³, D.W. Hanto^1
1Transplant Surgery, Beth Israel Deaconess Medical Center, Boston/MA/UNITED STATES OF AMERICA, ²Transplant Institute, Beth Israel Deaconess Medical Center, Boston/MA/UNITED STATES OF AMERICA, ³Transplant Institute, Beth Israel Deaconess Medical Center, Boston/UNITED STATES OF AMERICA

Body: Introduction: Although Blacks constitute 37% of the United States population receiving dialysis and 35% of those on the transplant waiting list, they receive just 13% of live-donor transplants. We postulate that differences in social networks may underlie this disparity. Odds of finding eligible donors depend on the health, financial status, willingness to be tested (social norms), and number of persons in social network (representing pool of potential donors). We hypothesize that networks of Black recipients might restrict the likelihood of LDKT in two ways: (1) limiting the number of eligible donors through limited education and poor health, (2) limiting informational diffusion about transplantation. Methods: We interviewed and reviewed medical records from a representative sample of 247 dialysis patients in the Greater Boston area (oversampling Blacks) about the role of social networks in their decision-making surrounding transplantation. Social networks were elicited using standard name generators used in social network studies. We examine the role of social network characteristics in explaining lower rates of transplantation, especially of LDKT. Results: We find that Blacks are more informed about transplantation as an option for End-Stage Renal Disease than their White counterparts, contradicting the notion that lack of information about transplantation underlies differences in transplantation rates. Blacks were more likely to think that transplantation was a good treatment option for most people as well as for themselves than Whites were (P<0.05). Differences persist in how Blacks learned about transplantation, with Whites more commonly learning about transplantation from a nephrologist, as opposed to Blacks, who were more likely to learn about transplantation from other clinical staff. Black and White patients were equally likely to discuss LDKT with their network members, suggesting that disparities in LDKT rates are not due to lack of discussion. Differences in network size (the number of people in the patient's social network) were not predictive, though differences in closeness of patients to persons in their network as well as network density (the degree to which people in the network are connected and close to one another) were predictive. This suggests that Black patients were closer to people in their networks and that networks were more closed (meaning that network members were connected to each other) (p<0.05). Though closed networks are thought to act more cohesively, they may pose a limitation in terms of obtaining a live donor, particularly if network members share key characteristics that may be contra-indications to transplantation (socioeconomic and health status). We found evidence for this, in that Black patients and their social network members were more likely to have a high school education or less compared to Whites, and were more likely to be in fair or poor health.
Conclusions: Social networks have been shown to confer risk of numerous health conditions and health behaviors, including precursors to CKD (e.g. obesity). Compositional differences in the health of social networks of Black patients suggest that fewer network members may be eligible for LDKT, and those who are eligible, may face more systemic barriers owing to poor socioeconomic position.

Disclosure: All authors have declared no conflicts of interest.