Transplant Trial Watch

Transplant social worker and donor financial assistance to increase living donor kidney transplants among African Americans: The TALKS Study, a randomized comparative effectiveness trial.

Boulware, L. E., et al.

American Journal of Transplantation 2020 [record in progress].


Aims
The aim of this study was to investigate whether a transplant social worker intervention (TALK SWI) when delivered alone or in combination with living donor (LD) financial assistance was more effective in increasing LD activation events among African American transplant canditates, compared to ususal care.

Interventions
Participants were randomised to one of three groups: the TALK SWI group, the TALK SWI plus financial assistance group, or the usual care group.

Participants
300 African American transplant candidates on the deceased donor kidney transplant waiting list.

Outcomes
The primary endpoint was the assessment of LD kidney transplant donor activation events on behalf of the study participants. The secondary endpoint was the assessment of transplant canditates’ pursuit of LD transplants.

Follow-up
12 months

CET Conclusions
The randomised controlled trial compared the incremental effectiveness of a transplant social worker intervention alone or paired with living donor financial assistance versus usual care on living donor activation events in African American candidates. 300 participants were randomised according to a computer-generated sequence with concealment of allocation. The social worker intervention addressed concerns previously identified among African American patients and families considering living donor kidney transplantation (LDKT), including medical distrust, financial concerns, and donor coercion. Most participants rated the social worker intervention as useful and 99% felt that the social worker was helpful. Only 2 out of 100 participants in the social worker paired with financial assistance group made use of the financial assistance. The intention to treat analysis showed that the overall rate of donor evaluation was low and that there were no statistically significant differences between groups over 12 months follow-up. There were also no statistically significant differences between groups for taking a step forward in LDKT pursuit.

Jadad score
3

Data analysis
Strict intention-to-treat analysis

Allocation concealment
Yes

Trial registration
ClinicalTrials.gov - NCT02369354

Funding source
Non-industry funded