NEWS | February 10, 2017

Language barriers may interfere with access to kidney transplantation

English language fluency may predict patients' status on the transplant waiting list


Language barriers may hinder U.S. kidney transplant candidates’ access to kidney transplantation, according to a new study in the Clinical Journal of the American Society of Nephrology.

Efrain Talamantes Efrain Talamantes

Led by a team from Cedars-Sinai, UCLA Health and UC Davis Health, the research suggests that patients who primarily speak a language other than English may face disparities that keep them from completing their kidney transplant evaluations and, ultimately, from receiving a transplant.

“Our research highlights the critical need to improve the kidney transplantation evaluation process for patients who are often left behind in health care — those who don’t speak English at all or who may not be fully comfortable discussing health concerns in English,” said lead author Efrain Talamantes, assistant professor of internal medicine at UC Davis Health and associate director of the UC Davis Center for Reducing Health Disparities. “We hope our work informs effective interventions and novel approaches that improve access to kidney transplants for our nation's increasingly diverse patient populations.”

Individuals with end-stage renal disease can get on a kidney transplant waiting list, but if they are “inactive” they are not eligible to receive a deceased donor kidney. The main reason for inactive status is incomplete transplant evaluations, or lack of progress with the testing required to become eligible for a kidney.

Of the more than 100,000 candidates on the kidney transplant waiting list in the U.S., approximately 30 percent are on inactive status. There are many potential reasons why a candidate might delay completing the testing required for transplant evaluation, according to Talamantes and senior author Edmund Huang, associate professor of nephrology with UCLA Health and acting associate professor in nephrology and the Kidney Transplant Program at Cedars-Sinai.

The researchers sought to find out if language barriers, or linguistic isolation, might impact access to the active transplant waiting list. They merged Organ Procurement and Transplantation Network/United Network for Organ Sharing data with zip code socioeconomic data from the 2000 U.S. census. They then determined the cumulative incidence of conversion to active waitlist status, death and delisting before conversion among 84,783 temporarily inactive adult kidney candidates from 2004 to 2012. A household was determined to be linguistically isolated if all members age 14 years or older spoke a non-English language and English less than “very well.”

Across all racial and ethnic groups, progressively higher degrees of linguistic isolation were linked with a lower likelihood of transitioning from inactive to active status on the kidney transplant waiting list and with incomplete transplant evaluations. Candidates living in a community with fewer than 20 percent linguistically isolated households were 29 percent less likely to achieve active waitlist status than those residing in a community with fewer than 1 percent linguistically isolated households. The associations of linguistic isolation and other socioeconomic factors appeared to be most influential among Hispanic candidates.

“Our data suggest that language barriers may limit an individual’s ability to receive a kidney transplant,” Huang said. “We recommend that patients with limited English proficiency who are in need of a kidney transplant use patient advocates who are English-proficient during transplant clinic visits and always use interpreters to get all of their questions answered.”

“Further, transplant centers and health care providers should actively address potential communication barriers when recommending testing for transplant evaluation,” Huang added.

Study co-authors, all from UCLA, were Keith Norris, Carol Mangione, Gerardo Soto, Amy Waterman, John Peipert and Suphamai Bunnapradist.

The study was funded by the Health Resources and Services Administration (T32HP19001 and 231000115), National Institutes of Health (P30AG021684, P30AG021684, UL1TR000124, R18DK105464, K23AG04296101 and P30AG021684), U.S. Centers for Disease Control and Prevention (U18DP006140), UCLA and Charles Drew University, Barbara A. Levey and Gerald S. Levey Endowed Chair in Medicine, American Federation for Aging Research and a Paul B. Beeson Career Development Award.

The article, entitled “Linguistic Isolation and Access to the Active Kidney Transplant Waiting list in the United States,” is available on the journal's website.

More information about UC Davis Health and its Department of Internal Medicine is at