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Minority Affairs Committee Update

March 13, 2012 MeetingChicago O’Hare Hilton

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Minority Affairs Committee Update

Educational Guidelines on Patient Referral to Kidney Transplantation

Disparities in Presentation of Transplant Information

Ongoing CPRA Analysis Update on New Proposed MAC

Projects

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Educational Guidelines on Patient Referral to Kidney Transplantation

• MAC Subcommittee formed to develop educational guidelines for providers regarding appropriate patient referral.

• Draft guidelines document has been approved by the Subcommittee and full Committee.

• Additional review by Kidney, Patient Affairs, Living Donor and Transplant Administrators Committee as well as professional transplant partner s (NKF, AST, ASTS, KDOQUI, AMAT, NTSW, etc.) will occur as part of an expanded Subcommittee.

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Disparities in Provision of Transplant Information

Many patients uninformed of kidney transplant options at time of 2728 filing.

Most common reason reported: patient not assessed at filing time.

Factors influencing likelihood of referral:• profit/non profit status of dialysis center• age, gender, ethnicity • obesity • insurance status (private vs. public) • under the care of a nephrologist prior to ESRD

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Evaluation of Calculated PRA (CPRA) Policy Evaluation of Calculated PRA (CPRA) Policy for Allocation of Deceased Donor Kidneys: for Allocation of Deceased Donor Kidneys:

Transplant Rates by Ethnicity and Transplant Rates by Ethnicity and Sensitization LevelSensitization Level

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Adult Kidney Registrations as of 2/10/12Adult Kidney Registrations as of 2/10/12

38% White, 34% Black, 18% Hispanic, 7% 38% White, 34% Black, 18% Hispanic, 7% Asian and 2% other ethnicities.Asian and 2% other ethnicities.16% -- CPRA value of 80-100%.16% -- CPRA value of 80-100%.9.8% waiting with current CPRA ≥ 98%, 9.8% waiting with current CPRA ≥ 98%, and of these, 43% were Black, 35% White, and of these, 43% were Black, 35% White, 14% Hispanic, 6% Asian, and 2% other 14% Hispanic, 6% Asian, and 2% other ethnicities.ethnicities.

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TX Rate Changes Post Policy TX Rate Changes Post Policy ImplementationImplementation

Significant decrease for non-sensitized Significant decrease for non-sensitized (CPRA 0%) and low sensitized CPRA 1-20%) (CPRA 0%) and low sensitized CPRA 1-20%) White, Black, and Hispanic candidatesWhite, Black, and Hispanic candidates

Significant increase for White, Black, and Significant increase for White, Black, and Asian moderately sensitized (CPRA 21-79%) Asian moderately sensitized (CPRA 21-79%) candidatescandidates

No significant change among American No significant change among American Indian/Alaska Native, Native Hawaiian/Other Indian/Alaska Native, Native Hawaiian/Other Pacific Islander, or Multiracial candidates, Pacific Islander, or Multiracial candidates, regardless of sensitization level.regardless of sensitization level.

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Changes in TX RatesChanges in TX Rates Significant increase for highly sensitized Significant increase for highly sensitized

(CPRA 80-100%) White, Black, and Hispanic (CPRA 80-100%) White, Black, and Hispanic candidatescandidates

Significant increase among White, Black, and Significant increase among White, Black, and Hispanic candidates with a CPRA of 80-97%, Hispanic candidates with a CPRA of 80-97%, but decrease (although not significant) in but decrease (although not significant) in transplant rates for those with CPRA of 98-transplant rates for those with CPRA of 98-100%. 100%.

This was also true for Asian candidates, This was also true for Asian candidates, although the decrease in transplant rates for although the decrease in transplant rates for those candidates with CPRA ≥ 98% was those candidates with CPRA ≥ 98% was significant.significant.

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Eligible Donor Conversion RatesEligible Donor Conversion RatesBy Region and EthnicityBy Region and Ethnicity

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Eligible Donor Conversion Rates, 2/1/08-11/30/11Eligible Donor Conversion Rates, 2/1/08-11/30/11by Year: All Regionsby Year: All Regions

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Eligible Donor Conversion Rates, 2/1/08-11/30/11Eligible Donor Conversion Rates, 2/1/08-11/30/11by Donor Ethnicity: All Regionsby Donor Ethnicity: All Regions

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Eligible Donor Conversion Rates, 2/1/08-11/30/11Eligible Donor Conversion Rates, 2/1/08-11/30/11by Year and Ethnicity: All Regionsby Year and Ethnicity: All Regions

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ResultsResults Across all regions and donor ethnicities the

donor conversion rate was 70.1% and it ranged from 67% in 2008 to 73% in 2011.

Overall conversion rate was the highest among donors of multiracial ethnicity (85%), followed by White donors (78%), Hispanics (67%), Blacks (55%), Asians (48%), Native Hawaiians/other Pacific Islanders (46%), and American Indians/Alaska Natives (40%).

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ResultsResults

Within each region, eligible donor conversion rates varied among donor ethnic groups.

Regions 4 and 6 seemed to have increasing conversion rates across different donor ethnic groups during 2008-2011.

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Update on New Proposed Committee Projects

Referral Survey to Assess Barriers to Thoracic Transplantation

Minority Donor Conversion Rates