Survey Shows 60 Percent of Those with Kidney Disease See Transplantation As a "Last-Resort" Option, Despite Better Outcomes for Those Receiving Transplants Before Dialysis

Research Highlights Need for Improved Education

New York, NY (October 28, 2009) — Original research, published in the November issue of the American Journal of Nursing (AJN), found that 60 percent of non-transplanted patients with kidney disease perceive transplantation as a "last-resort" option. This is despite the fact that those who receive kidney transplants before starting dialysis have lower rates of morbidity and mortality than those who undergo transplantation after dialysis. In 2005, fewer than 2.5 percent of patients in the United States with end-stage kidney disease underwent transplantation as initial therapy.1

"The survey found that emotional barriers or gaps in education are the two major factors behind the misperception that dialysis must precede transplantation," said Genevieve Coorey, MA, BSN, RN, quality assurance and program director at the National Kidney Foundation. "Patients need to be taught that avoiding even a year of chronic dialysis can significantly improve health outcomes." Coorey noted that transplantation can also decrease Medicare expenditure by about $58,000 (34 percent) per patient over the first two years of kidney replacement therapy.

To explore barriers to early transplantation, in 2007 the National Kidney Foundation (NKF) surveyed 3,586 patients randomly selected from its database. The 28-question survey focused on socioeconomic factors, perceptions, fears and concerns about living donor transplantation and barriers to learning about transplant as a treatment option.

Results indicated that those who received transplants before starting dialysis had higher incomes and more education. They were also more likely to be white and to have learned about treatment options from a physician. Barriers to early transplantation among patients with progressive kidney disease include the lack of a timely referral by a health professional and the fact that patients are not always informed that transplantation has better outcomes when pursued early. There are also financial considerations and potential psychosocial barriers, such as anxiety and misunderstanding about the process, along with reservations about finding and approaching a potential living donor.

"As the author points out, this survey indicates that both real and perceived barriers to early transplantation persist," said Diana J. Mason, RN, PhD, FAAN, editor-in-chief emeritus of AJN. "The responses reveal how vital the nurse's role is for reinforcing the importance of timely education, problem solving, advocacy and facilitating patient-physician communication if early transplantation is to become a reality."

About the American Journal of Nursing

The American Journal of Nursing (AJN) is the leading voice of nursing and the most established nursing journal in the world, since 1900 ( It has received numerous awards for editorial excellence and dissemination of information. It is published by Lippincott Williams & Wilkins (

About the National Kidney Foundation

The National Kidney Foundation, a major voluntary nonprofit health organization, is dedicated to preventing kidney disease, improving the health and well-being of individuals and families affected by kidney disease and increasing the availability of kidneys for transplantation.

In 2009 NKF launched a groundbreaking multifaceted collaborative initiative to "End the Wait!" for a kidney transplant in the United States in 10 years by using proven strategies to eliminate barriers to donation and institute best practices across the country. For more information visit

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1 Abecassis M, et al. Kidney transplantation as primary therapy for end-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) conference. Clin J Am Soc Nephrol 2008;3(2):471-80.