Socioeconomic status a significant barrier to living kidney donation for African Americans

Socioeconomic status is a more important barrier to living kidney donation than cultural factors, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings may be useful for determining ways to increase living kidney donation in the United States.

Living donor kidney transplantation is the treatment of choice for patients with kidney failure. It is well described that African American patients with kidney failure have reduced access to kidney transplantation. Therefore, looking at patterns of living kidney donation in the African American population is important to better understand the barriers to donation within this community.

Previous studies that have examined barriers to living donor kidney transplantation in African Americans have primarily focused on recipient-related factors. Jagbir Gill, MD, MPH (University of British Columbia, in Vancouver) and his colleagues wanted to examine the issue from the perspective of living kidney donors to better understand what barriers may limit kidney donation among African Americans and White Americans. "Specifically, we wanted to determine the relative impact of both socioeconomic status and race on living kidney donation rates in African American and White populations in the United States," said Dr. Gill.

Using 1998 to 2010 data from the Organ Procurement Transplantation Network/United Network of Organ Sharing, US Renal Data System, and the US Census, the researchers examined the complex association of race and median household income with living kidney donation. The analysis included 57,896 donors.

Among the major findings:

• Income status was strongly associated with living kidney donation: lower income populations had lower rates of living kidney donation compared with higher income populations among both African Americans and Whites.
• In low income populations, African Americans had lower rates of kidney donation compared with White Americans, but in high income populations, African Americans actually had higher rates of kidney donation compared with White Americans.

"These results suggest that for African Americans, socioeconomic status is a more important barrier to living kidney donation than cultural factors. The findings are surprising and will have significant implications on strategies to increase living kidney donation in the United States," said Dr. Gill. Specifically, efforts to increase living kidney donation should target the barriers that are specific to lower socioeconomic populations.