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Transplantation. 2013 Sep;96(6):586-90. doi: 10.1097/TP.0b013e31829b754c.

Modifiable factors in access to living-donor kidney transplantation among diverse populations.

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1 Psychiatry-Medical Psychology and Psychotherapy, Erasmus MC, CA Rotterdam, The Netherlands. 2 Internal Medicine-Nephrology & Transplantation, Erasmus MC, CA Rotterdam, The Netherlands. 3 Address correspondence to: Sohal Y. Ismail, M.Sc., Psychiatry-Medical Psychology and Psychotherapy, Erasmus MC, Postbox 2040, Room GK-1252, 3000 CA Rotterdam, The Netherlands.



We have observed a significant inequality in the number of living-donor kidney transplants (LDKT) performed between patients of non-Western European origin and those of Western European origin. The aim of this study was to investigate modifiable factors that could be used as potential targets for an intervention in an attempt to reduce this inequality.


A questionnaire on knowledge, risk perception, communication, subjective norm, and willingness to accept LDKT was completed by 160 end-stage renal patients who were referred to the pretransplantation outpatient clinic (participation rate of 92%). The questionnaire was available in nine languages. Multivariate analyses of variance were conducted to explore differences between patients with and without a living donor.


There were significantly fewer patients of non-Western descent (11 of 82) that brought a living donor to the outpatient clinic than patients of Western descent (38 of 78). After correcting for the unmodifiable sociodemographic factors non-Western descent, low knowledge, little communication about their kidney disease, and low willingness to communicate with individuals from the social network about LDKT were significantly associated with the absence of a living donor.


Knowledge and communication are identified as modifiable factors that are associated with the likelihood of identifying a potential living donor for LDKT. This observation makes knowledge and communication targets for interventions to reduce inequality in access to LDKT.

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