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Disparities/Minority Health

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People who have experienced discrimination in the past may be more reluctant to be put on kidney transplant lists

Many patients with end-stage renal disease (ESRD) who receive kidney transplants live longer and feel better than those who remain on hemodialysis. Yet, women who are ESRD patients are three times less likely than men to be included on kidney transplant waiting lists. People saying they accepted unfairness as a "fact of life" were three times less likely to be listed as those who did not. Also, those who had experienced racial discrimination, whether in the purchase of a home or interacting with the criminal justice system, were seven times less likely than other similarly ill patients to be placed on kidney transplant waiting lists, according to a study supported by the Agency for Healthcare Research and Quality (HS08136).

Among those who were not listed, older patients were 10 times less likely than younger patients to desire a transplant. Individuals who had experienced sexual, racial, or both types of discrimination and those who felt that the rich and important get transplants more quickly than others were six times less likely to desire a transplant. Finally, those resigned to the idea that a fairer organ donor system was probably not achievable were nearly 8 times less likely to want a transplant.

It is important that culturally competent providers be aware of the potential influence of past discriminatory experiences on patient decisions about kidney transplants. They should discuss transplantation issues with these reluctant ESRD patients, suggests Ann C. Klassen, Ph.D., of the Johns Hopkins School of Public Health. Dr. Klassen and her colleagues reviewed patient records from three Baltimore-area hemodialysis units and conducted face-to-face interviews with transplant-eligible patients and with unit staff members in 1996 and 1997.

See "Relationship between patients' perceptions of disadvantage and discrimination and listing for kidney transplantation," by Dr. Klassen, Allyson G. Hall, Ph.D., Brit Saksvig, Ph.D., M.H.S., and others, in the May 2002 American Journal of Public Health 92(5), pp. 811-817.

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