Socioeconomic factors, not culture, the culprit to low living kidney donations
Friday, August 30, 2013, Vancouver BC – A new study by a St. Paul’s Hospital transplant nephrologist finds socioeconomic status supersedes cultural factors as it relates to living kidney donation. The study, published in the Journal of the American Society of Nephrology (JASN), examined living kidney donation rates in the African American and White populations in the United States (US).
Cultural differences have often been cited as a barrier to living kidney donation in certain racial and ethnic groups; however, Dr. Jagbir Gill and his colleagues found a strong correlation between median household income and living kidney donation, with significantly lower rates of living donation in lower income populations, irrespective of race. Dr. Gill is a transplant nephrologist at St. Paul’s Hospital and assistant professor of medicine at UBC.
“Although this study was conducted using data from the United States, its findings may have implications for Canadians as well. Unlike the U.S., our health care system ensures access to quality health care irrespective of one’s financial situation. However, there are a number of expenses associated with living kidney donation that are not fully covered in our system, such as lost wages from taking time off work to recover from surgery – often amounting to one to two months. These data suggest that people with better financial means may be more willing and able to absorb those expenses,” said Dr. Gill.
The study also shows that while African Americans with lower incomes were less likely to donate than White American populations, the same was not true in high income brackets. Higher income African Americans were more likely to be living kidney donors than higher income white Americans, suggesting that income, not cultural beliefs, is the major barrier for living donation in African Americans.
“It suggests that some of the ethnic and racial differences we see in living kidney donation may be due to socioeconomic rather than cultural factors. This is something that likely needs to be examined more closely in Canada,” said Gill.
The first living kidney transplant in BC happened in 1976. Since then there have been 1,546. Last year there were 83 living kidney donor transplants, so far this year there have been 79. In 2012, BC had 19.6 living donors per million people, well above the Canadian average of 16.3.
BC also led the way in establishing a living organ donor expense reimbursement program (LODERP) to assist donors with costs associated, including some loss of income. The program was initially funded by BC Transplant and is now administered by the Kidney Foundation of Canada (BC branch). It has since become a national program.
The study was co-authored by James Dong, MS, Caren Rose, MS, David Landsberg, MD, Olwyn Johnston, MD, MS, and John Gill, MD, MS. Researchers examined data from 1998 to 2010 from the Organ Procurement Transplantation Network/United Network of Organ Sharing, US Renal Data System, and the US Census, cross-referencing race and median household income with living kidney donation. In all, 57,896 donors were analyzed.
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Angela White, St. Paul's Hospital Volunteer