Like other areas of health and health care, there are racial disparities in kidney transplant, which is the best treatment for kidney failure. African Americans are almost half as likely as White patients to receive a kidney transplant. No previous research in the Southern U.S. (with the greatest transplant disparities) has focused on African American patients' experiences with racism, racial prejudice, and discrimination and their impact on kidney transplant parity. This study examines these phenomena and can inform nephrology social work practice. Dialysis social workers are the professionals who often provide the most assistance to patients in their pursuit of transplant.
Partnering with the National Kidney Foundation, this community-engaged and interdisciplinary project uses qualitative content analyses of in-depth interviews with 100 African Americans in a southern US state who are on dialysis. We used a combination of deductive and inductive approaches for analyses, establishing a preliminary codebook of provisional codes guided by our interview prompts. We elucidated and described emergent themes in the data through using comments to paraphrase participant narratives. We then added emergent codes to the provisional codebook, refining the codebook in an iterative fashion. Patients received a $100 incentive for completing the interview. Data are analyzed qualitatively using MAXQDA software.
Results: The most prominent themes that emerged from the analyses included the impact of racism and discrimination on: 1. access to kidney transplants, 2. gaps in education, understanding and awareness of kidney transplant, and 3. the quality of life of people living with kidney disease. Most respondents desire a kidney (80%), few express concerns or reservations regarding transplantation surgery (18%), but fewer than one-third (29%) received a referral on the kidney transplant wait list. Few patients report receiving information from their kidney health providers on how to receive a kidney – especially from nephrologists (8%) and nurses (13%). While more than half (57%) of the interviewed patients receive some information from their social worker only, most patients demonstrated limited knowledge and awareness regarding the kidney transplantation process. Many respondents also report that White patients are treated better than them; often attributing these patterns of differential treatment to differences in class (e.g., income, poverty), race or residential context (e.g., rural, suburb, urban).
Conclusions and Implications: Racial disparities have long existed in kidney transplantation, yet the impact of racism and discrimination on these health inequities are under-studied. This study can offer insight into new interventions and research to help improve kidney transplant parity. Findings can also help inform social work practice in dialysis and transplant centers- social workers can tailor their interventions to include issues of racism and discrimination as they work with patients to help them get kidney transplants.