Introduction: End-stage liver disease patients who receive transplants from living donors have post-transplant outcomes as good or better than those transplanted with livers from deceased donors. Recent data suggest black patients are less likely to receive LDLTs compared to white patients. However, barriers to LDLT and different types of barriers faced by black and white patients have not been studied.

Methods: We conducted semi-structured interviews in-person or via telephone of white and black deceased and living donor transplant recipients, white and black patients on the liver transplant waitlist, and their social supports. Subjects completed 20-30 minute interviews that covered asking someone to donate, experiences with healthcare, and social support. Interviews were transcribed and coded for themes using Nvivo software.

Results: Of 54 completed and transcribed interviews, there were 12 unique black patients (recipients or waitlisted patients) plus 4 related social supports or donors, and 29 unique white transplant patients (recipients or waitlisted patients) plus 9 related social supports or donors. Among 41 waitlisted patients or transplant recipients, 20 (48.8%) never asked anyone to donate. Of the remaining 21, 7 had someone ask on their behalf (33.3%), 5 asked someone directly (23.8%), 5 asked in a purposely indirect manner (23.8%), 3 asked directly in a group family setting (14.3%), and 3 asked via social media (14.3%). Commonly stated reasons for not asking were beliefs that potential donors would be ineligible, concern over surgery risks, concern over the impact of recovery for potential donors, and anxiety over asking someone to donate. Of 12 black patients, 6 (50%) had asked at least one person compared to 15/29 (51.7%) white patients. However, of these black patients, only 3 (50%) had a potential living donor step forward, compared to 11 (73.3%) white patients. Of 11 black patients who did not ask a living donor or were unsuccessful in finding a donor, 7 (63.6%) actually turned down offers to donate compared with only 6/19 (31.2%) white patients. Commonly stated reasons for turning down an offer were guilt over risks to donors and a low sense of urgency.

Conclusion: The greatest barrier to a recipient finding a living donor was the recipient's own level of discomfort. Transplant programs may need to place a greater emphasis on normalizing living donation for patients and aim to remove the stigma behind asking.

CITATION INFORMATION: McCauley M, Goldberg D, Nephew L, Kalman R, Forde K. Reasons for Racial Disparities in Living Donor Liver Transplants (LDLT). Am J Transplant. 2017;17 (suppl 3).

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