Self-advocacy is associated with lower likelihood of living donor kidney transplantation

A Cozette Killian; Rhiannon D Reed; Alexis Carter; M Chandler McLeod; Brittany A Shelton; Vineeta Kumar; Haiyan Qu; Paul A MacLennan; Babak J Orandi; Robert M Cannon; Douglas Anderson; Michael J Hanaway; Jayme E Locke

doi:10.1016/j.amjsurg.2020.12.035

Self-advocacy is associated with lower likelihood of living donor kidney transplantation

Am J Surg. 2021 Jul;222(1):36-41. doi: 10.1016/j.amjsurg.2020.12.035. Epub 2020 Dec 24.

Authors

Affiliations

¹ University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA. Electronic address: akale@uabmc.edu.
² University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA. Electronic address: rdeierhoi@uabmc.edu.
³ University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA. Electronic address: alexiscarter@uabmc.edu.
⁴ University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA. Electronic address: marshallcmcleod@uabmc.edu.
⁵ University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA. Electronic address: brittanyshelton@uabmc.edu.
⁶ University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA. Electronic address: vkumar@uabmc.edu.
⁷ University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA. Electronic address: hyqu@uab.edu.
⁸ University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA. Electronic address: pmaclennan@uabmc.edu.
⁹ University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA. Electronic address: borandi@uabmc.edu.
¹⁰ University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA. Electronic address: rmcannon@uabmc.edu.
¹¹ University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA. Electronic address: douglasanderson@uabmc.edu.
¹² University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA. Electronic address: mhanaway@uabmc.edu.
¹³ University of Alabama at Birmingham Comprehensive Transplant Institute, 701 19th Street South, LHRB 790, Birmingham, AL, 35233, USA. Electronic address: jlocke@uabmc.edu.

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.

Keywords: Advocacy; Disparities in LDKT; Living donor kidney transplantation (LDKT); Navigator program; Transplantation.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Black or African American / statistics & numerical data
Donor Selection / standards
Donor Selection / statistics & numerical data*
Female
Health Services Accessibility / standards
Health Services Accessibility / statistics & numerical data
Healthcare Disparities / statistics & numerical data*
Humans
Kidney Failure, Chronic / surgery*
Kidney Transplantation / standards
Kidney Transplantation / statistics & numerical data*
Living Donors / statistics & numerical data
Male
Marital Status / statistics & numerical data
Middle Aged
Patient Advocacy / statistics & numerical data*
Retrospective Studies
Sex Factors
White People / statistics & numerical data

Abstract

Publication types

MeSH terms

Grants and funding