11 Aug Why Does Georgia Have the Lowest Rate of Kidney Transplantation?
MedicalResearch.com Interview with:
Rachel Patzer, PhD, MPH
Director of Health Services Research,
Emory Transplant Center
Assistant Professor
Department of Surgery Division of Transplantation
Emory University School of Medicine
Medical Research: What is the background for this study? What are the main findings?
Dr. Patzer: There are two main treatments for patients with end stage kidney disease: dialysis or kidney transplantation. Kidney transplantation offers the best survival and quality of life compared to dialysis. However, there is a limited supply of organs in the U.S., so not all patients with end stage organ failure get a kidney transplant. Certain regions of the country have lower access to kidney transplantation than other regions. The Southeastern United States (GA, NC, and SC) has the lowest rates of kidney transplantation in the nation, and Georgia (GA) is the state that ranks at the very bottom.
Our research team and collaborators from the Southeastern Kidney Transplant Coalition sought to examine some of the reasons for why Georgia had the lowest rates of kidney transplantation in the nation. The transplant centers in our Coalition collaborated to share data on patient referrals from dialysis facilities, where the majority of end stage renal disease patients receive treatment, to transplant centers in Georgia. Referral from a dialysis facility to a transplant center is required for patients to undergo the extensive medical evaluation that is required for a patient to either be placed on the national deceased donor waiting list, or to receive a living donor kidney transplant (e.g. from a friend or family member).
There were several major findings:
1) That overall, referral of patients from a dialysis facility to a kidney transplant center is low (only about 28% of patients with kidney failure are referred to a transplant center within a year of starting dialysis).
2) There was much variation in referral for transplantation across dialysis facilities in GA, where some facilities referred no patients within a year, and others referred up to 75% of their patient population.
Medical Research: What should clinicians and patients take away from your report?
Dr. Patzer: Physicians in dialysis facilities are required to discuss transplantation as a treatment option with all of their patients with end stage kidney disease within the first few months of starting treatment. However, there are no standard guidelines for what this conversation should entail. Clinicians should explain the benefits of transplantation to their patients, and work with the patients to remove any potential barriers that the patient may face. Be an advocate for your patients! We recommend that if there is any uncertainty into whether the patient is eligible for a transplant, they should be referred for transplant so that the transplant center can do a detailed medical evaluation to make that determination.
For patients, it is important to be your own advocate. You can ask your doctor, nurse, or social worker questions about what is involved in the kidney transplant process. You can also self-refer to a transplant center.
Medical Research: What recommendations do you have for future research as a result of this study?
Dr. Patzer: This study was conducted in Georgia only, due to the availability of referral data. There are no national sources of referral data, so it is unknown whether these findings are generalizable to the rest of the United States. Our future research involves collecting more data on referral patterns for dialysis facilities outside of just Georgia. We also have ongoing work to intervene on the dialysis facilities in our region with the lowest rates of referral. We are providing educational materials and support for dialysis facility leadership, staff, and patients to try and improve referral for kidney transplantation for patients.
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Rachel Patzer, PhD, MPH (2015). Why Does Georgia Have the Lowest Rate of Kidney Transplantation?
Last Updated on August 11, 2015 by Marie Benz MD FAAD