Document text
Principal Investigator: Elisa J Gordon
Organization: VANDERBILT UNIVERSITY MEDICAL CENTER
Fiscal Year: 2024
Award: $241,318
Funding agency: National Institute of Diabetes and Digestive and Kidney Diseases
PROJECT SUMMARY/ABSTRACT
Due to the organ shortage, more than 15,000 patients with end-stage liver disease (ESLD) are waiting for a
life-saving liver transplant (LT) in the US, but fewer than 50% of waitlisted patients will go on to receive a LT.1
As a result, more than 2,000 LT waitlisted patients die each year. Racial disparities compound the organ
shortage: ESLD rates are increasing in the Black population, but Black patients receive disproportionately
fewer LTs than White patients.2 Living donor liver transplantation (LDLT) is a safe and effective treatment that
increases organ availability for LT.3 Yet Black ESLD patients receive fewer than 10% of LDLTs. Efforts to
redress these disparities are urgently needed.
Assessing multilevel factors that affect Black potential LT recipients (LTR) along with potential living liver
donors (LLDs) is essential for developing interventions that foster equity in access to LDLT. In particular,
understanding how social determinants of health (SDOH) mediate racial disparities in access to LDLT is a
critical barrier to equity in access to LDLT because SDOH-related barriers are concentrated in racial minorities.
Few retrospective studies have identified patient-level factors associated with disparities in access to LDLT
(e.g., distance to transplant center, insurance, and neighborhood income). Understanding the mechanisms of
the interaction between potential LLD and LTR experiences during the transplant and donor selection process
is critical to effectively targeting interventions designed to improve access to LDLT to both the donor and
recipient experiences.
The objective of the proposed study is to assess multilevel factors contributing to disparities in
access to the LT waitlist and LDLT for Black patients with ESLD and potential LLDs. In this descriptive
study, we will compare access to LT and LDLT among Black and White patients at two transplant centers with
large Black ESLD patient populations (Nashville, TN, and Durham, North Carolina). We will engage LDLT
stakeholders (i.e., potential LTRs, potential LLDs, and transplant clinicians) to identify multilevel barriers,
facilitators, and strategies for overcoming barriers to LT and LDLT using mixed methods. We will leverage
findings to develop an intervention designed to foster equity in LT and LDLT, and assess its feasibility using
implementation science. The specific aims are to:
1. Assess center documented multi-level factors contributing to racial disparities in LT and LDLT
2. Characterize patient perceived multi-level factors that influence access to LT and LDLT
3. Assess the interaction between multilevel factors contributing to racial disparities in LT and LDLT over time
Study results will inform the development of a culturally sensitive, multilevel, transplant center-based
intervention to increase Black patients’ access to LDLT, and to save lives.
Terms: <Address><Affect><Black><Black Populations><Black group><Black individual><Black people><Black race><Blacks><Care Givers><Caregivers><Chronic Disease><Chronic Illness><Clinical><Data Bases><Databases><Decision Making><Development><Disparities><Disparity><Donor Screening><Donor Selection><Donor person><Economic Income><Economical Income><Equity><Fostering><Goals><Hepatic Transplantation><Improve Access><Income><Insurance><Intervention><Intervention Strategies><Interview><Kidney Grafting><Kidney Transplantation><Kidney Transplants><Knowledge><Learning><Life><Link><Liver><Liver Grafting><Liver Transplant><Living Donor Liver Transplantation><Living Donors><Mediating><Medical><Methods><Monitor><National Academy of Sciences><Neighborhoods><North Carolina><Organ><Patients><Perception><Persons><Play><Process><Racial Equity><Renal Grafting><Renal Transplantation><Renal Transplants><Reporting><Research><Retrospective Studies><Retrospective cohort><Risk><Source><System><Time><Time Study><Transplant Recipients><Transplantation><United States National Academy of Sciences><Waiting Lists><Weight><Work><access disparities><accessibility disparities><black patient><chronic disorder><data base><developmental><disparities in access><disparities in race><disparity due to race><disparity in ethnic><effective therapy><effective treatment><end stage liver disease><end stage liver failure><ethnic based disparity><ethnic disadvantage><ethnic disparity><ethnic inequality><ethnic inequity><ethnicity disparity><experience><health record><hepatic body system><hepatic organ system><implementation science><incomes><inequality due to race><inequality in access><inequity due to race><inequity in access><inequity in accessibility><informant><intervention design><interventional strategy><kidney tx><live kidney donor><liver transplantation><living kidney donor><patient population><prospective><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial disparity><racial inequality><racial inequity><racial minority><racially unequal><social health determinants><therapy design><transplant><transplant centers><transplant donor><transplant patient><treatment design><waitlist><weights>