End stage renal disease
(ESRD) is the last stage of chronic kidney disease or kidney failure.
Dialysis, which is a process used to remove wastes and toxins from the blood,
are the two procedures needed to stay alive.
Unlike dialysis which is
performed routinely, kidney transplantation is done when a suitable donor kidney
is found and you don't have any new medical problems. You will have to go
through various assessments and lab tests, and when the surgery team finds that
the donor kidney is in good condition and suitable for you, they will quickly
prepare you for the surgery.
The Kidney Transplant Procedure is as follows:
diseased kidney is left as it is unless it is causing pain or is infected.
incision is made in your lower abdomen to the front.
Blood vessels from your lower abdomen are connected to the blood vessels of the
ureter of the donated kidney is connected to your bladder.
stent may be inserted in the ureter to ensure a good flow of urine. The stent
is removed in 6 to 10 weeks through a procedure called cystoscopy.
incision is closed with surgical stitches, surgical staples or glue.
Regional Disparities in
Kidney Transplantation Access
Unfortunately, all ERSD
patients in the United States do not have access to kidney transplantation,
though there are more than 4000 dialysis
facilities. Dr. Rachel
Patzer and her team at the Emory University School of Medicine found that there
is substantial geographic variation in access to kidney transplantation, with a
disproportionate lack of access in the Southeast. Southeastern region includes
the states of Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina,
South Carolina, Tennessee, and Virginia.
The research team looked
for characteristics of dialysis facilities that were linked with delayed access
to kidney transplantation. They found that the following had lower rates of
African American patients •
Uninsured patients •
Patients with diabetes •
Profit making companies •
Facilities with fewer staff
The lowest performing
dialysis facilities were in the Southeast and the highest in the Northeast.
Poverty is the main reason for this inequity, the researchers found.
'The disparities that we
have reported in access to kidney transplantation within dialysis facilities in
the Southeastern US are linked to the higher concentration of poverty in this
area of the country compared to other regions,' said Dr. Patzer.
The researchers offered
various strategies to address the disparities in access to kidney
transplantation. For example, they suggested that:
performing facilities could focus on internal quality improvement activities •
Making policy changes to increase staffing •
Standardizing patient education •
Titte Srinivas, MD, of
the Medical University of South Carolina, notes that the inequity in access
among kidney failure patients in the Southeast reflects the 'interaction of
patients' socioeconomic and biologic factors with the financial and
organizational structure of the healthcare system'. Poverty and lack of
education are the main barriers to the access of kidney transplantation,
according to him.
It is also a reflection
of population health since organ
from living donors is limited by the health of the donor
population. Dr Srinivas suggested the need to use 'top-down' approach in the
health care delivery system to improve the population health in the Southeast.
Racial Disparities in
Access to Kidney Transplantation
In another study
published in the American Journal of Transplantation, Dr Rachel Patzer and her
team found that black patients had a 59 percent lower rate of transplantation
over that of white patients. The study examined 2,291 patients, nearly
two-thirds of whom were black and a third lived in low-income areas, to
determine the effect of race on referral, evaluation, wait-listing, and organ
health care coverage for end-stage renal disease (ESRD) patients through the
Medicare ESRD program, black ESRD patients are at a disadvantage to receive
kidney transplantation,' Dr. Patzer reported. 'Socioeconomic status really
accounts for about 30% of this observed racial disparity in transplant access.'
She suggested that
patient education may help reduce racial disparities in access to kidney
Ultimately, whether it
is the regional disparity or racial disparity, socioeconomic status of the ESRD
patient is the main barrier to the access of kidney transplantation.