Transplant Navigator Intervention to Overcome Barriers to Kidney Transplantation

Compared with chronic dialysis treatment, kidney transplantation generally offers a longer
life span, a better quality of life, and lower health care costs for the over 500,000
Americans with End Stage Renal Disease. Despite Medicare funding of virtually all kidney
transplants, minority, female, and poor patients with End Stage Renal Disease have decreased
access to kidney transplantation. In prior work, the investigators identified the steps in
the transplant process that are responsible for creating these disparities. These include
medical suitability, interest in receiving a transplant, referral to a transplant center for
a pre-transplant workup, placement on a waiting list or identification of a living donor,
and receipt of a kidney from a deceased or living donor. The investigators now propose to
train transplant recipients to act as transplant navigators and then test the value of using
transplant navigators to help patients and providers complete these steps.

The proposed community-based randomized controlled trial will involve approximately 75-100
adult hemodialysis patients at intervention dialysis facilities and approximately 75-100
patients at control facilities to compare a transplant navigator intervention with usual
care over a 24 month interval. Baseline evaluation will include sociodemographic and
medical characteristics, specific steps completed in the transplant process, and barriers to
moving forward in the transplant process. At periodic intervals, the navigator will provide
tailored information and assistance to patients and their nephrologists to help them
complete the tasks required at each step. The major outcome will be completion of
additional steps in the transplant process. Secondary analyses will examine impediments to
successful intervention among subjects who fail to move forward in the transplant process
despite assistance from a navigator.

The proposed project will test a novel intervention that targets patients and nephrologists
as they together make transplant-related decisions. Future work will involve determining
the impact of navigators on disparities in transplant rates, examining the
cost-effectiveness of transplant navigators, and disseminating the intervention for use
across the country. Helping patients complete steps in the transplant process may lead not
only to improved access to kidney transplantation but also to better patient survival,
decreased health care costs, and increased quality of life.