Friday, May 15, 2009

Disparities in Transplantation

In previous posts, I have addressed the clinical benefits that come if organ transplantation programs are of sufficient size. There are also knowledge benefits that accrue to society when programs are large enough to support research. Here's an example, a recent article investigating the sources of racially-correlated treatment disparities in this field -- a serious and important public policy issue.

The article, in the American Journal of Transplantation, is entitled "Framing Disparities Along the Continuum of Care from Chronic Kidney Disease to Transplantation: Barriers and Interventions." It was prepared by Keren Ladin, James Rodrigue, and Douglas Hanto, from our Center for Transplant Outcomes and Quality Improvement and Harvard's Department of Health Policy. I'm sorry that only the abstract is available without a subscription. I've copied a portion of the article above to give you a feeling for it. Here is the abstract:

Research in renal transplantation continues to document scores of disparities affecting vulnerable populations at various stages along the transplantation process. Given that both biological and environmental determinants contribute significantly to variation, identifying factors underlying an unfairly biased distribution of the disease burden is crucial. Confounded definitions and gaps in understanding causal pathways impede effectiveness of interventions aimed at alleviating disparities. This article offers an operational definition of disparities in the context of a framework aimed at facilitating interventional research. Utilizing an original framework describing the entire continuum of the transplant process from diagnosis of chronic kidney disease through successful transplant, this article explores the case of racial disparities, illustrating key factors predicting and perpetuating disparities. Though gaps in current research leave us unable to identify which stages of the transplant pathway adversely affect most people, by identifying key risk factors across the continuum of care, this article highlights areas suited for targeted interventions and presents recommendations for improvement and future research.


Douglas Hanto said...

Dear Paul,
Thanks for highlighting this work. We are particularly interested in identifying the casuses of disparities that occur along the entire continuum from the developement of kidney disease to transplantation in order that we can design interventions to correct these disparities. We believe that you can't just intervene at one point in the process, but must intervene at many different points in order to impact the ultimate outcome. I would be happy to email anyone of your readers a PDF file of the entire article.
Doug Hanto

Paul Levy said...

Thanks, Doug. Readers can write to Doug directly at dhanto [at]bidmc [dot] harvard [dot] edu. Tell him you saw it here!