Document Type



Doctor of Philosophy



Date of Defense


Graduate Advisor

Kuei-Hsiang Hsueh


Kuei-Hsiang Hsueh

Anne F. Fish

Wilma J. Calvert

Rick Zimmerman


The dissertation attempts to address the disparity seen in all transplant centers today, the low number of African-American end-stage renal disease(ESRD) patients pursing kidney transplant as renal replacement therapy. Currently, there are two renal replacement options, dialysis or a kidney transplant. Research has shown that kidney transplant provides the best health care outcomes in terms of quality of life and decrease mortality. While African-Americans carry the burden of the disease by being four times more likely to have ESRD they only represent 1/3 of the kidney transplants done in the United States. There have been three attempts to increase access to kidney transplant for all minorities, including African-Americans. The first was in 2005 by The Centers for Medicare and Medicaid Services, mandating all patients be informed of their transplant options within 45 days of initiating dialysis. The second was in 2010 requiring the use of clear communication through the Plain Writing Act. The third change was in 2014 by changing point allocation for patients listed for a deceased donor kidney, by giving harder to match patients, points for their length of time being on the transplant waitlist. Yet, African-Americans transplant rates remain low. Many studies have focused on barriers to transplant, for example, transplant knowledge, with significant results but effects are not large compared to standard education. This dissertation attempts to address this gap by broadly reviewing the evidence of best of practices in designing educational material, examining the educational preparation interventions for kidney transplant, and identify any associations and predictors of personal factors and health literacy skills in African-Americans pursuing kidney transplant, all to aid in reducing this disparity.