1. Write a brief paragraph discussing what social determinants are most relevant to your area of research and why. Consider both structural stratifiers (e.g. income, education, etc) and intermediary determinants such as material and psychosocial circumstances, as described in the WHO reading. Explain why you chose the factors (might use Braveman article from last week to provide justification. The association could be reported in published research or it could be your hypothesized relationship. Consider whether how these factors might function over the lifecourse and/or intergenerationally.
Social determinants play a major role in the filed of nephrology and kidney transplantation. One of the areas of research that I’m interested in is access to kidney transplantation and kidney donation. Iran is the only country in the world that has a legalized paid kidney donation model and this model is being advertised as a solution to organ shortage be implemented in other countries. However, there are major concerns about social disparities in this paid donation model. Iranian paid kidney donors have been shown to be mostly young married men who are unemployed or have a low-paying job who donate their kidneys to be able to start a small business like buying a car and working as a cab driver. Many of these donors have been shown to experience a stressful life event before donation and have a high rate of depression and regret post-donation. I conducted a research project comparing Iranian related living kidney donors versus paid donors and showed that paid donors, despite being younger and having a shorter post-donation time, had a lower rate of participation in our study and had significantly lower quality of life and higher incidence of albuminuria, pointing out that they are at high risk of developing kidney disease in long-term. This study along with other studies have shown that Iranian paid kidney donors are at high risk for poor outcomes post-donation and need a higher level of support and education before and after donation. Therefore, before this paid donation system can be implemented in other countries, the social disparities associated with this system need to be addressed.
2. Write a brief paragraph describing the extent to which an socioecological framework incorporating issues related to social determinants has been applied to your area of research. Are there opportunities for improving our understanding of or approach to disparities in your area with a greater emphasis on a socioecological framework?
Social disparities in access to kidney transplant in US is an area of research that I’m interested in. Most of the research that has been done in this area has focused on racial disparities in access to kidney transplant showing that African Americans and Latinos have a lower rate of access to kidney transplant even after correction for education or income level. The framework that has formed around this racial disparity has focused on lack of education on benefits of kidney transplant and living donation, mistrust of the medical system and financial disincentives for kidney donation in US. The potential opportunities for improving our approach to disparities in kidney transplant should focus on improving culturally tailored education in primary care and nephrology settings, reduce financial disincentives to kidney donation and preventing the unnecessary disqualification of potential living donors from racial minorities.
Comparison of Health Status and Quality of Life of Related Versus Paid Unrelated Living Kidney Donors
M. K. Fallahzadeh, L. Jafari, J. Roozbeh, N. Singh, H. Shokouh‐Amiri, S. Behzadi, G. A. Rais‐Jalali, M. Salehipour, S. A. Malekhosseini, M. M. Sagheb
https://ucsf.idm.oclc.org/login?url=https://doi.org/10.1111/ajt.12488
The End of Racial Disparities in
Kidney Transplantation? Not So Fast!
Winfred W. Williams and Francis L. Delmonico
JASN August 2016, 27 (8) 2224-2226; DOI: https://ucsf.idm.oclc.org/login?url=https://doi.org/10.1681/ASN.2016010005
Association of Racial
Disparities with Access to Kidney Transplant After the Implementation of the
New Kidney Allocation System
Sanjay Kulkarni, MD, MHCM1; Keren Ladin, PhD, MSc2; Danielle Haakinson, MD1; et alErich Greene, PhD3; Luhang Li, MS3; Yanhong Deng, MPH3
JAMA Surg. 2019;154(7):618-625. doi:10.1001/jamasurg.2019.0512
Addressing
Disparities in Living Donor Kidney Transplantation
Krista L. Lentine, Didier Mandelbrot
CJASN Dec 2018, 13 (12) 1909-1911; DOI: 10.2215/CJN.06250518