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Featured Clinical Reviews

August 11, 2015

Improving Access to Kidney Transplantation: Referral Is Not Enough

Author Affiliations
  • 1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
  • 2Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
JAMA. 2015;314(6):565-567. doi:10.1001/jama.2015.8932

Kidney transplantation is the optimal treatment for eligible patients with end-stage renal disease (ESRD), offering longer life expectancy and better quality of life compared with chronic dialysis treatment.1 However, only 13% of patients who develop ESRD join the deceased donor waitlist or receive a transplant from a live donor within 1 year,2 and many patients who lack access to kidney transplantation are predicted to have excellent posttransplant outcomes.3 Furthermore, pervasive disparities in access to kidney transplantation persist despite decades of recognition and efforts to improve equity in transplant access,1,4 with African Americans, Hispanics, women, older adults, patients of lower socioeconomic status or without private insurance, those living in high-poverty neighborhoods, and those receiving dialysis at a for-profit center less likely to undergo kidney transplantation.5-9

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