All ETDs from UAB

Advisory Committee Chair

Martha S Wingate

Advisory Committee Members

Justin Blackburn

Lisle Hites

Jayme E Locke

Paul A Maclennan

Document Type

Dissertation

Date of Award

2019

Degree Name by School

Doctor of Public Health (DrPH) School of Public Health

Abstract

As the prevalence of kidney disease continues to increase in the United States, the gap between the need for organs and available kidney donors is growing as well. Deceased donor organs alone are insufficient to meet this need, and transplant centers have turned their focus to living donation to address the shortage. However, the frequency of living kidney donation has been declining in the US since 2004. Changes in the health of the US population have been suggested as one possible explanation for the decline, but currently these assertions remain anecdotal. A second theory with more published evidence attributes the insufficiency of living donor kidneys to patient reluctance to reach out and ask others to become kidney donors, particularly among minorities, perhaps due to studies demonstrating increased risk of adverse post-donation outcomes. To address this concern, strategies have arisen to alleviate the transplant candidate’s burden of asking for a kidney by training of advocates. Unfortunately, these strategies have failed to focus on 1) the perspective of potential living donors, 2) addressing donor comfort and confidence in the evaluation/donation process, 3) and considering actual reasons for non-donation. The aim of my dissertation is thus to describe the association between population-level factors and lower rates of living kidney donation through the use of data from the Behavioral Risk Factor Surveillance System and to analyze the effectiveness of the Living Donor Navigator program at increasing living donation at the University of Alabama at Birmingham. Herein I explore population health and socioeconomic status as potential barriers to increasing rates of living donation (paper #1), whether the Living Donor Navigator Program has achieved its goal of increasing donor approvals in a cost-effective way (paper #2), and qualitatively describe early impressions of the Living Donor Navigator Program to define core competencies and promising practices for implementation (paper #3).

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