Promoting Access to Renal Transplantation: The Role of Social Support Networks in Completing Pre-transplant Evaluations

  • Cheryl R. Clark
  • Leroi S. Hicks
  • Joseph H. Keogh
  • Arnold M. Epstein
  • John Z. Ayanian
Original Article



Completing pre-transplant evaluations may be a greater barrier to renal transplantation for blacks with end-stage renal disease (ESRD) than for whites.


To determine whether social support networks facilitate completing the pre-transplant evaluation and reduce racial disparities in this aspect of care.

Design, Setting, and Participants

We surveyed 742 black and white ESRD patients in four regional networks 9 months after they initiated dialysis in 1996 and 1997. Patients reported instrumental support networks (number of friends or family to help with daily activities), emotional support networks (number of friends or family available for counsel on personal problems) and dialysis center support (support from dialysis center staff and patients). The completion of pre-transplant evaluations, including preoperative risk stratification and testing, was determined by medical record reviews.

Outcome Measurement

Complete renal pre-transplant evaluations.


Compared to patients with low levels of instrumental support, those with high levels were more likely to have complete evaluations (25% versus 46%, respectively, p < .001). In adjusted analyses, high levels of instrumental support were associated with higher rates of complete evaluations among black women (p < .05), white women (p < .05), and white men (p < .05), but not black men. Among black men, but not other groups, private insurance was a significant predictor of complete evaluations.


Instrumental support networks may facilitate completing renal pre-transplant evaluations. Clinical interventions that supplement instrumental support should be evaluated to improve access to renal transplantation. Access to supplemental insurance may also promote complete evaluations for black patients.


racial disparities social support networks instrumental support renal transplantation pre-transplant evaluation 


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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Cheryl R. Clark
    • 1
    • 2
    • 3
  • Leroi S. Hicks
    • 1
    • 2
    • 3
    • 4
  • Joseph H. Keogh
    • 5
  • Arnold M. Epstein
    • 1
    • 6
  • John Z. Ayanian
    • 1
    • 4
    • 6
  1. 1.Division of General Medicine and Primary CareBrigham and Women’s HospitalBostonUSA
  2. 2.Center for Community Health and Health EquityBrigham and Women’s HospitalBostonUSA
  3. 3.Brigham and Women’s—Faulkner Hospitalist ProgramBrigham and Women’s HospitalBostonUSA
  4. 4.Department of Health Care PolicyHarvard Medical SchoolBostonUSA
  5. 5.CliGnosisBostonUSA
  6. 6.Department of Health Policy and ManagementHarvard School of Public HealthBostonUSA

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