Dialysis Social Workers' Perspectives on Barriers and Facilitators to Kidney Transplantation

Introduction: Dialysis social workers are integral in the transplant evaluation process; however, research on dialysis social workers' perspectives on access to kidney transplantation is limited. Methods: A mixed methods study examining dialysis social workers' perspectives on transplant barriers and facilitators. Dialysis social workers completed online surveys and participated in virtual, semi-structured interviews. Qualitative data were recorded, transcribed, and analyzed using thematic analysis. Quantitative data were analyzed descriptively. Results: Twenty-seven dialysis social workers completed surveys, and 15 participated in qualitative interviews. Participants were predominantly female (93%) and White (89%). While the majority (67%) had practiced as a social worker for 6+ years, most had ≤5 years of dialysis experience (52%). The majority described the transplant referral process as somewhat easy (67%) and rated their relationship with transplant programs as either fair or good (78%). Both survey and interview data identified similar patient-level barriers, such as lack of social support and obesity. Interviews further elucidated organizational and system level barriers including tensions between dialysis and transplant centers, transplant center accessibility, and systemic discrimination. Identified facilitators included patient motivation, transplant center communication, and transplant resources. Conclusion: Dialysis social workers provided a unique perspective on barriers and facilitators to kidney transplantation. While barriers to transplant were often considered at the patient level, organizational and system level factors were crucial to understanding transplant access. These findings could inform future efforts between dialysis and transplant centers to improve access to kidney transplantation.