Adventist University of Health Science
DNR499: Seminar in Nursing
Rilla Taylor, Instructor
October 7, 2014
Renal transplants are successful alternative to dialysis, however ethnical minorities have less access to renal transplantations and higher graft rejections. There are many factors that contribute to this health disparities in ethnic minorities. Lifestyle, immunologic factors, and geographic have an effect on the post-transplantation graft rejection within ethnic group.
Ethnical minorities in the United States (US) have less access to kidney transplants; the national waiting period in US is 4-6 years. Patients added to the 2001 kidney candidate list had about 70% White, 54% African Americans, and 57% Asians patients who received a kidney in a 5 year period. The mortality rate is higher in non-White patients compared to white patients on the waiting list. End-stage renal disease (ESRD) is higher in ethnic groups and half of the patients of the waiting list in the US are ethnic minorities.
These ethnic groups are predisposing to renal insufficiency due to other comorbidities, such as diabetes and hypertension (HTN). “African Americans account for more than 33%” of ethnical groups waiting a transplant. (Malek, Keys, & et al., 2010)They have an increase need for organs. African Americans are less likely to be placed on the waiting list due to the lack of adequate pretransplant care. Studies also show that African Americans are less likely to believe that their quality of life will improve after kidney transplantation and are reluctant to seek care due to past discriminations in healthcare. Lower social status and education contributes to poor compliance with medications and lack of health insurance. More African Americans are below the poverty level and uninsured compared to White people. African Americans have a higher chances of environment toxins exposure to cause HTN and impaired renal functions (Malek, Keys, & et al., 2010).
Another factor to health disparities in ethnical groups are physicians’ perceptions to treatment and ethnical groups. A study on 278 nephrologist determined that physicians were less likely to believe a renal transplantations will improve survival rate in African Americans compared to white patients. There is a limited availability of living donors for Blacks. Also, immunologic factors increase the risk of acute rejection in African American because of the HLA polymorphism. Matching HLA, compatibility, and comorbidities play an important role. It’s hard for ethnical groups to find a matching HLA donor compared to White patients. Post transplantation, Blacks have a higher immune response