A Culturally Targeted Transplant Program

The shortage of organs for kidney transplantation for patients with end-stage renal disease
(ESRD) is magnified in Hispanics/Latin Americans. Hispanics have a disproportionately higher
prevalence of ESRD, yet receive fewer kidney transplants compared to non-Hispanic whites.
Living donor kidney transplant (LDKT) is the treatment of choice for ESRD as it confers
better patient and graft survival, shorter waiting time, and better quality of life than
deceased donor kidney transplantation. However, compared to their representation on the
waiting list, fewer Hispanics received a LDKT than non-Hispanic whites in 2013: 4% versus
10%. Barriers to LDKT for Hispanics include: lack of knowledge, cultural concerns, and
language barriers. The disparity will likely worsen without intervention as Hispanics are the
largest and fastest growing minority group in the US.

Few available culturally competent interventions have led to increased LDKT rates.
Interventions rarely address Hispanic cultural concerns, and there are no published models of
transplant center-based only programs. The Chicago Northwestern Medicine's® Hispanic Kidney
Transplant Program (HKTP), a culturally and linguistically competent program, has increased
Hispanic LDKTs. The mean annual ratio of Hispanic to non-Hispanic white LDKTs grew from 0.20
in 2001-2006 to 0.34 in 2008-2013, a 70% increase (p<0.001).

The objective of this study is to implement and evaluate the HKTP, a culturally-competent
transplant center-based intervention, at two transplant centers serving large Hispanic
populations (Dallas, TX, and Los Angeles, CA), with Northwestern University serving as the
Study Coordinating Center. The pre-post HKTP intervention study will evaluate the effect of
the HKTP's key culturally sensitive components (outreach, communication, education) on
Hispanic LDKT rates, compared to matched controls. The specific aims are to:

1. Implement the HKTP at two transplant centers by conducting a needs assessment of
barriers and using a "learning collaborative" model to deliver HKTP protocols, scripts,
and materials.

2. Conduct a pre-post HKTP intervention evaluation with matched controls to assess if the
HKTP is associated with an increase in: a) the ratio of Hispanic to non-Hispanic white
LDKTs as a function of an absolute increase in Hispanic LDKTs, b) ESRD Hispanic patient
additions to the waiting list, c) Hispanic potential donors per potential recipient, and
d) Hispanic patients' satisfaction with care.

3. Formatively evaluate the fidelity and innovative adaptations to HKTP's outreach,
communication, and education at both study sites to identify effective components of the
HTKP, using mixed methods.

As an exploratory aim, a budget impact analysis will be conducted to construct a business
case for transplant centers and permit estimates of HKTP scalability. The proposed study will
provide valuable knowledge about the potential to rapidly disseminate the HKTP as a novel
approach to increase Hispanic LDKTs nationally, improve health outcomes for Hispanics, and
close the LDKT disparity gap.

Inclusion Criteria:

- Hispanic or non-Hispanic white potential recipients initiating evaluation for a
transplant

- age 18 or older

- The above potential recipients' potential donors initiating evaluation for living
donation

Exclusion Criteria: