Making House Calls Increases Living Donor Inquiries and Evaluations for Blacks

[Clark]

http://www.ncbi.nlm.nih.gov/pubmed/24825528

Making House Calls Increases Living Donor Inquiries and Evaluations for Blacks on the Kidney Transplant Waiting List.
Rodrigue JR1, Paek MJ, Egbuna O, Waterman AD, Schold JD, Pavlakis M, Mandelbrot DA.
Transplantation. 2014 May 12. [Epub ahead of print]

Abstract
BACKGROUND:
Blacks receive live donor kidney transplant (LDKT) less often than patients of all other races. We evaluated the effectiveness of educational interventions in removing barriers to LDKT for blacks.
METHODS:
Patients were randomized to three interventions in which health educator(s) delivered an intervention to (a) the patient and his/her guests in the patient's home (house calls [HC], n=54), (b) clusters of patients and their guests in the transplant center (group based [GB], n=49), and (c) the individual patient alone in the transplant center (individual counseling [IC], n=49).
RESULTS:
At the 2-year endpoint, 15% (n=8), 8% (n=4), and 6% (n=3) of HC, GB, and IC patients, respectively, received LDKT (P=0.30). Patients in the HC group were more likely than patients in the GB and IC groups to have at least one donor inquiry (82% vs. 61% vs. 47%, P=0.001) and evaluation (65% vs. 39% vs. 27%, P<0.001). Patients in the HC group also were more likely to have higher knowledge, fewer concerns, and higher willingness to talk to others about donation 6 weeks after intervention.
CONCLUSIONS:
These findings underscore the importance of including the patient's social network in LDKT education and the potential of the HC intervention to reduce racial disparity in LDKT rates.
PMID: 24825528

[Clark]

http://livingdonorsarepeopletoo.com/autonomy-doesnt-mean-what-you-think-it-does-transplant-industry/

“Autonomy” doesn’t mean what you think it does, transplant industry
By LDPeopleToo

I stopped reading articles claiming to be about the ‘ethics’ of living organ donation long ago, because they all justify the systemic neglect and harm of living donors by citing “patient autonomy”. They conveniently forget that our greater responsibility is not to hurt someone: not if they put themselves in a position to be hurt, and not even if they “consent” to being hurt. It is simply something that an ethical person does not do if it is avoidable. And if it is unavoidable, the obligation is to keep the harm to a bare minimum.
Today I ran across this study by members of the transplant industry, who would, if asked, state that they care very much about donor safety, that they do not, in any way, prioritize the recipient over the living donor.  Yet, their actions in this study, and its conclusion, advocate sending “educators” to would-be recipients’ HOMES and soliciting – oh, er, I mean educating –  their friends and families about why they should donate a kidney to their sick loved one.
 
In case you didn’t connect the dots yourself, here it is: IT IS IMPOSSIBLE TO CLAIM PATIENT AUTONOMY WHEN MEMBERS OF THE TRANSPLANT INDUSTRY ARE ACTING AS KIDNEY BROKERS.
 
Yes folks, this is brokerage pure and simple. Transplant surgeons and transplant centers don’t get paid unless there’s an organ to transplant. Since deceased donors don’t appear on-demand, what’s a starving hospital to do?
Find more living donors!
And what better way than by exploiting people’s personal relationship under the guise of “education”, spinning a yarn regarding the horror of kidney disease and dialysis while hyping the miracle of transplant. If necessary, sprinkle in some living donor risk minimization, but only if someone asks. Otherwise, avoid that topic completely. All we need to do right now is to convince – er, persuade – er, no I mean EDUCATE – someone into that first blood draw.
After all, once we tell ‘em they’re a match, we’ve got ‘em hooked.
 
Worst part is, they don’t even have the decency to be ashamed of themselves. They’ve convinced themselves they’re doing the best thing for their patients. Problem is, living donors are patients too.