Testing the Differential Access Hypothesis That Black Kidney Transplant Candidates Perceive Social Network Access to Fewer Potential Living Donors Than White Candidates

Abstract

IntroductionMany studies of Black–White disparities in living donor kidney transplantation hypothesize that they were partially due to Black–White differences in candidate social network access to healthy, willing donors. This differential access hypothesis has not been tested using directly measured social network data.Research QuestionsDo black kidney transplant candidates have perceived lower social network access to health and/or willing living donors than white candidates?DesignA cross-sectional survey that measured the social network members was collected in 2015. Black–White differences in patient counts of perceived healthy and/or willing potential donors in social networks, and individual network members’ probability of being perceived healthy and/or willing, were compared using logistic and negative binomial regression models.ResultsThe survey included 66 kidney transplant candidates reporting on 1474 social network members at a large Southeastern US transplant center in 2015. Black and White patients had similar access to perceived healthy, likely potential donors (86% vs 87% had 1 or more, P = .92; 5.91 vs 4.13 mean counts, P = .20) and perceived healthy, agreed potential donors (56% vs 48%, P = .54; 1.77 vs 1.74, P = .97). Black patients’ network members were individually more likely to be perceived healthy and likely potential donors (26% vs 21%, P = .04), and White patients’ network members were more likely to have agreed (13% vs 9%, P = .03), but these differences were statistically insignificant in demographically adjusted models.ConclusionBlack and White transplant candidates perceived access to similar numbers of potential donors in their social networks. This result does not support the differential access hypothesis.