Barriers to cadaveric renal transplantation among blacks, women, and the poor.
BACKGROUND
Cadaveric renal transplantation rates differ greatly by race, sex, and income. Previous efforts to lessen these differences have focused on the transplant waiting list. However, the transplantation process involves a series of steps related to medical suitability, interest in transplantation, pretransplant workup, and movement up a waiting list to eventual transplantation.


OBJECTIVE
To determine the relative importance of each step in explaining differences in cadaveric renal transplantation rates.


METHODS
Prospective cohort study.


METHODS
A total of 7125 patients beginning long-term dialysis between January 1993 and December 1996 in Indiana, Kentucky, and Ohio.


METHODS
Completion of 4 separate steps during each patient-year of follow-up: (A) being medically suitable and possibly interested in transplantation; (B) being definitely interested in transplantation; (C) completing the pretransplant workup; and (D) moving up a waiting list and receiving a transplant.


RESULTS
Compared with whites, blacks were less likely to complete steps B (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.61-0.76), C (OR, 0.56; 95% CI, 0.48-0.65), and D (OR, 0.50; 95% CI, 0.40-0.62) after adjustment for age, sex, cause of renal failure, years receiving dialysis, and median income of patient ZIP code. Compared with men, women were less likely to complete each of the 4 steps, with ORs of 0.90, 0.89, 0.80, and 0.82, respectively. Poor individuals were less likely than wealthy individuals to complete steps A, B, and C, with ORs of 0.67, 0.78, and 0.77, respectively.


CONCLUSIONS
Barriers at several steps are responsible for sociodemographic differences in access to cadaveric renal transplantation. Efforts to allocate kidneys equitably must address each step of the transplant process.
School of Medicine, Case Western Reserve University, Cleveland, OH, USA.
G C
GC
Alexander
A R
AR
Sehgal
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D002102:Cadaver; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009820:Ohio / Q000453:epidemiology; D018579:Patient Selection; D011203:Poverty / Q000706:statistics & numerical data; D011446:Prospective Studies; D040841:Resource Allocation; D012935:Social Justice; D012959:Socioeconomic Factors; D014019:Tissue Donors; D014850:Waiting Lists; D044465:White People / Q000706:statistics & numerical data