MUSC team addresses transplant disparities

When it comes to health disparities in the United States, the problems start at birth and end at death. Infant mortality rates for blacks are about double those of whites. And differences in hypertension, diabetes, heart disease and other maladies are profound and troubling.

What's worse, these illnesses have a cumulative effect, sometimes resulting in severe kidney disease. When kidneys fail, the options are two: dialysis and transplant.

About 70 percent of people on the kidney transplant waiting list are black, according to Dr. Prabhakar K. Baliga, head of the Division of Transplant Surgery at the Medical University of South Carolina. They wait an average of 420 days, compared with 261 days for whites. Only 15 percent of living donors are black, he said.

The hard numbers reveal a huge gap caused by many factors, including socioeconomic reasons, cultural practices and attitudes, racism, mistrust and religious fatalism, Baliga said. Because of these factors, blacks often fail to receive timely testing and treatment.

In a 2006 paper, Baliga and seven of his colleagues explored the issue, asking whether there is a lack of willing donors or an excess of unsuitable donor candidates. The answer, it turns out, appears to be both.

With help from a two-part National Institutes of Health grant, Baliga and his colleagues are reaching out to communities in an effort to generate trust and encourage early intervention. Transplant education classes, which once were offered only at the hospital and combined with medical evaluation, have been modified. "Otherwise, it would have been too much to digest," Baliga said.

The classes are held in Charleston, Greenville and Columbia and include no doctors, only nurses, social workers and financial advisers, he said. That way, participants don't need to travel as far and can avoid the often threatening hospital environment.

Baliga said changes also have been made in how information is presented to patients. Rather than emphasize the radical nature of transplant surgery, the focus is on success rates, symptoms, risk factors and treatment options.

Medical staff make an effort to meet with patients and their families before dialysis begins, to build trust, educate and re-orient their thinking, he said.

"Transplant is the better option in terms of prolonging your life and quality of life," he said.

As for identifying potential organ donors, Baliga said, the team chips away at mistrust and doubt by explaining the process in detail.

Fears are exaggerated in communities that don't fully understand the risks and benefits of transplant, he said.

A normal, healthy person with one kidney is at no increased risk, he said. And a recipient of a living donor's kidney can maintain a normal quality of life, unhindered by hours attached to a dialysis machine. It's a win-win.

Reach Adam Parker at 937-5902 or aparker@postandcourier.com.