# The RaDIANT Health Systems Intervention for Equity in Kidney Transplantation

> **NIH NIH R01** · INDIANA UNIVERSITY INDIANAPOLIS · 2024 · $495,165

## Abstract

Abstract
For most patients with end-stage kidney failure, kidney transplantation confers longer survival, better quality of
life, and lower cost, relative to dialysis. Despite these benefits, too few patients make it through the complex
transplant evaluation process, and long-standing racial and socioeconomic inequities exist in access to each
transplant step, including referral, start and completion of the transplant evaluation, and placement on the
waiting list. In 2010, with the explicit goal of improving equity in access to transplant in the US Southeastern
region that includes Georgia, North Carolina, and South Carolina, we created the Southeastern Kidney
Transplant Coalition, a community of transplant stakeholders, including patients, caregivers, medical
professionals, patient advocacy groups, and health system administrators that encompasses all 10 transplant
centers in these states and large dialysis organizations serving a population of >50,000 patients with kidney
failure. Since its inception, our Coalition has conducted several pragmatic interventions of educational and
quality improvement activities at the dialysis facility, provider, and patient levels, finding increased rates of
referral and evaluation start, and reduced racial disparities in these outcomes among Black vs. White patients
and those with lower vs. higher socioeconomic status. Unfortunately, health system barriers persist after
referral and education: more than half of patients referred did not start the transplant evaluation, and 65% of
those referred were never waitlisted. However, prior interventions were limited to interventions at the patient-
and dialysis facility-levels and did not address the structural barriers in the complex process across the health
systems that patients must navigate to get a transplant, including both dialysis facilities and transplant centers.
In surveys of health system staff and a scoping review, we identified persistent health system barriers to
transplant equity, including scheduling logistics, inadequate provider communication across health systems,
and limited transplant provider awareness of inequities. In this proposed RaDIANT Health Systems
intervention, we will leverage proven interventions from our research and use a community-based participatory
research approach to adapt and enhance sustainability of the RaDIANT interventions targeting structural
barriers to evaluation start at the health system level (Aim 1). We will then conduct a hybrid type 1
effectiveness-implementation quasi-experimental study of the RaDIANT Health System intervention among 4
Southeastern transplant centers and ~800 dialysis facilities in GA, NC, and SC with a goal of reducing racial
and socioeconomic inequities in transplant access (Aim 2). Finally, we will conduct a process evaluation
among the participating health systems to assess acceptability, usability, implementation, and sustainability of
interventions (Aim 3). If successful, interventions coul...

## Key facts

- **NIH application ID:** 10878876
- **Project number:** 5R01DK136283-02
- **Recipient organization:** INDIANA UNIVERSITY INDIANAPOLIS
- **Principal Investigator:** Stephen Pastan
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2024
- **Award amount:** $495,165
- **Award type:** 5
- **Project period:** 2023-07-01 → 2028-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10878876

## Citation

> US National Institutes of Health, RePORTER application 10878876, The RaDIANT Health Systems Intervention for Equity in Kidney Transplantation (5R01DK136283-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10878876. Licensed CC0.

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