Differences in Family and Financial Stress and the Decision to Donate in Black and White Living Renal Donors

Abstract

Background: Blacks have one of the highest rates of end stage renal disease in the U.S. but receive living kidney donations at a far lower rate than Whites. Transplant programs in the U.S. work to promote autonomous decision making in living organ donors. However, there may be racial differences in preferences for involving family in important decisions such as donation and in the amount of family stress prior to donation.

Purpose: To explore differences in preferred family involvement in the decision to donate and to examine differences in family and financial stress between Black and White kidney donor candidates.

Methods: In interviews during donor evaluation, we asked how donors preferred to involve family in the decision to donate. We also measured family stress and family income. Three months after donation we interviewed donors about their satisfaction with their care while in the hospital and after discharge.

Results: Among 174 living kidney donors, Blacks who made up 21% of the sample, were younger (p = .01), had higher levels of family stress in the year before donation, p = .01) and were more likely to report a total household annual income of 40,000 or less (p = .001) than Whites. Blacks were more likely to donate to a family member than a non-family member but were more likely to say that they made the decision to donate without family input (p = .01) than Whites. At three months, there were no significant differences in satisfaction with care during and after hospitalization between Blacks and Whites respectively.

Conclusions: Transplant professionals should be aware that Black donor candidates may have greater levels of family stress than White donors. The lack of racial differences in the experience of donation may provide some reassurance to Black donor candidates who worry that they might have a more negative experience compared to White donor candidates. Financial risks should be carefully explained or support considered for donors with limited income who might more readily suffer negative financial consequences if recovery takes longer than anticipated.