Lyndsay S. Baines

Kidney Transplantation and Gender Disparity

Gender inequity in access to hemodialysis and kidney transplantation has created a public health crisis in the US. Women have a lower chance of receiving hemodialysis and kidney transplant than men, but they constitute the majority of living kidney donors. Research has shown that economic factors such as greater income of men may encourage females to be donors; while gender-bias on part of physicians or institutions, lack of social support networks and differences in health-seeking behaviors compared to men are cited as reasons for this imbalance. We suggest various strategies to improve participation of women in the transplant process by education; raising awareness by publishing gender-specific data for dialysis and transplant centers; education and workshops to eliminate gender-bias within institutions and health-care providers and establishment of gender-specific support groups. Transplant teams that are more sensitive to the social complexities of women’s lives may lead to increased understanding of the effects of renal disease and indicate measures that need to be in place in order to address this gender disparity in the treatment of renal failure. Research needs to be done to elucidate the underlying medical, societal or psychological processes that lead to gender bias in the field of kidney transplantation.

Psychosocial profiling: a holistic management tool for non-compliance*

Abstract:  We introduce a new concept of psychosocial profiling as a tool that provides the transplant team with a psychosocial framework for identification, intervention and management of non‐compliance. This will also increase our understanding of emotional problems experienced by patients before transplant, as a result of living with the uncertainty and medical side effects of chronic illness. Psychosocial profiling is adaptable throughout the transplant process and gives every patient an opportunity of psychosocial support to help him or her into a position of emotional stability and compliance with their medications and postoperative care. Implementation of this strategy will move health care professionals from being gatekeepers to managers and facilitators of holistic care in recipients of transplants.

Non-Adherence Codes in the New ICD-10: Need for Prospective Trials.

1. Non adherence is a significant factor in post transplant graft loss 2. The authors (e.g. Baines, Jindal) suggest that ICD-10 fails to consider the emotional and psychological issues faced by renal patients

RE: Indo-Asian experience of renal transplantation in Yorkshire: results of a 10-year survey.

We read with interest the article by Jeffrey et al. (1), which surveyed over time access to, allocation of, and subsequent postkidney transplant survival among Asians in Bradford, United Kingdom. The findings suggested that whereas Asians had similar access to the waiting list as their white counterparts, they had a significantly reduced chance of being allocated an organ, and even when they did receive a transplant, their survival rate was inferior. The primary reason put forward for this state of affairs was difficulties with human leukocyte antigen matching arising from the apparent reluctance of the Asian community toward donation. They concluded that the reasons for lack of organ donation in the Asian community are likely to be “complex.” However, what they do not say is that the answers to these complex reasons are not purely in the domain of medicine and epidemiology, but are also likely to lie within the sociomedical and relational component of the community, namely, in the field of medical sociology. Therefore, because their study was largely based on medical epidemiology, they did not have scope for in-depth discussion. We (and others) have investigated this issue on the basis of education and religious and racial discrimination within Asian communities in the United Kingdom (2–4). Our own findings from a community-based educational transplant forum conducted among Asians in Glasgow, Scotland, suggested that the reasons for paucity of organ donation among Asians are indeed complex (4). Over 300 members of the Asian community attended the information forum, and 80 attendees completed the sociologic survey. Our findings suggested that there was almost no opposition to organ donation in the Asian community. Furthermore, they were aware that religious leaders in the United Kingdom had endorsed organ donation and were unhappy that Asians were suffering as a result of a lack of organs. In particular, there was a favorable response to live donation and little discrimination with regard to the gender, age, or social role relationship between donor and recipient. However, to our own dismay, their favorable disposition toward organ donation was not accompanied by the carrying of an organ donor card. Detailed analysis of the sociologic survey suggested that although Asians were in favor of organ donation, they were not emotionally connected to the issue. To facilitate an emotional connection, we suggested that the concept of organ donation, and more specifically, the emotional and medical distress associated with living with an enduring prognosis (chronic renal failure), needed to be integrated into the Asian culture through use of the arts, literature, media, and cuisine. The two groups that appeared to be best placed to do this appeared to be religious leaders who might be used as cultural “integrators” as opposed to their more traditional role of cultural “prescribers.” The second group is mothers over the age of 30 who, although they appeared to hold less social, economic, and political power in the community, were central to the “social networks” and in a position of centrality regarding communication (4). We suggest that to promote organ donation among the Asian or any other minority racial groups, sociologic investigation aimed at understanding the values, attitudes, and beliefs of that community needs to parallel any medical, epidemiologic, or educational initiatives.

Utilizing Distance Learning to Incorporate Global Mental Health Capacity Into Humanitarian and Post-Conflict Missions

Global Mental Health (GMH) is an emerging field of scientific education, research, advocacy, and intervention that takes a worldwide perspective of classifiable mental, neurological,and substance misuse disorders.1 A sustainable and effective GMH service reduces cross-border threats and human security vulnerabilities while promoting resilience and capabilities of individuals and the wider community.spikes in communities acutely stressed by post-conflict environments. In addition to the direct harm domestic violence afflicts on its victims, it also leads to wider levels of criminal activity in the community and thus further impairs the community’s return to preconflict baseline.