title: Living donor kidney transplantation among ethnic minorities in the Netherlands: a model for breaking the hurdles.
abstract: OBJECTIVE
  Despite living donor kidney transplantation (LDKT) being the optimal treatment option for patients with end-stage renal disease, we observed a significant inequality in the number of LDKT performed between patients of Dutch versus non-Dutch descent. We conducted a focus group study to explore modifiable hurdles to LDKT.
  
  
  METHODS
  Focus group discussions and in-depth interviews were conducted among 50 end-stage renal patients. Analyses were conducted according to 'grounded theory' using Atlas.ti.
  
  
  RESULTS
  We found nearly all patients to be in favor of LDKT (96%). However, multiple factors played a role in considering LDKT. Four potentially modifiable hurdles were derived: (1) inadequate patient education, (2) impeding cognitions and emotions, (3) restrictive social influences, and (4) suboptimal communication. With regard to solutions, we found that our patients were open to home-based group education on renal replacement therapy options (88% in favor).
  
  
  CONCLUSIONS
  The study highlights the need for sensitivity and awareness of the influence of cultural factors on decision-making when discussing living donation with culturally diverse populations.
  
  
  CONCLUSIONS
  Since the majority of our patients were open to a tailored group education in their own homes, we see this as an opportunity to address factors that influence equality in access to LDKT.
authors.affiliation: Erasmus MC, Department of Medical Psychology, Rotterdam, The Netherlands. s.ismail@erasmusmc.nl
authors.forename: Sohal Y
authors.initials: SY
authors.lastname: Ismail
authors.forename: Lily
authors.initials: L
authors.lastname: Claassens
authors.forename: Annemarie E
authors.initials: AE
authors.lastname: Luchtenburg
authors.forename: Joke I
authors.initials: JI
authors.lastname: Roodnat
authors.forename: Willij C
authors.initials: WC
authors.lastname: Zuidema
authors.forename: Willem
authors.initials: W
authors.lastname: Weimar
authors.forename: Jan J V
authors.initials: JJ
authors.lastname: Busschbach
authors.forename: Emma K
authors.initials: EK
authors.lastname: Massey
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D003142:Communication; D003469:Culture; D003657:Decision Making; D005006:Ethnicity / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D007668:Kidney; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000523:psychology / Q000601:surgery; D016030:Kidney Transplantation / Q000208:ethnology* / Q000523:psychology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010353:Patient Education as Topic; D012959:Socioeconomic Factors; D009927:Tissue and Organ Procurement; D055815:Young Adult