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

• Published in: The American journal of surgery Vol. 222; no. 1; pp. 36 - 41
• Main Authors: Killian, A. Cozette, Reed, Rhiannon D., Carter, Alexis, McLeod, M. Chandler, Shelton, Brittany A., Kumar, Vineeta, Qu, Haiyan, MacLennan, Paul A., Orandi, Babak J., Cannon, Robert M., Anderson, Douglas, Hanaway, Michael J., Locke, Jayme E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.07.2021; Elsevier Limited
• Subjects: Advocacy; Blood & organ donations; Candidates; Confidence intervals; Disparities in LDKT; Hemodialysis; Kidney transplantation; Living donor kidney transplantation (LDKT); Navigator program; Patients; Statistical analysis; Training; Transplantation; Transplants & implants; Variables; Advocacy; Transplantation; Living donor kidney transplantation (LDKT); Disparities in LDKT; Navigator program
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2020.12.035

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. 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. 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). Advocacy training was beneficial for self-advocates, but having an independent advocate may increase the likelihood of LDKT. [Display omitted] •Self-advocates were primarily female, Black, and unmarried.•Self-advocates had lower likelihood of LDKT compared to patients with an advocate.•Having a spouse/significant other advocate was significantly associated with LDKT.•LDN enrollment significantly increased donor screenings for both advocate types.