Degree Date

5-2022

Document Type

Dissertation - Public Access

Degree Name

Ph.D. Doctor of Philosophy

Academic Discipline

Community Psychology

First Advisor

Suzette Fromm Reed, PhD

Second Advisor

Judah Viola, PhD

Third Advisor

David San Filippo, PhD

Abstract

Introduction/Background

The social contract of health (SCOH) in America that governs healthcare interactions has listed toward provider organizations and away from the patient. End stage renal disease treatment provides an explicatory case to examine an unbalanced SCOH. The study evaluates whether the robot-assisted kidney transplantation (RAKT) technique allows for patients with higher body mass indices and of burdened socioeconomic and sociodemographic status improved access to transplant compared to traditional open kidney transplant (OKT).

Methods

The study set combined extant data for patients transplanted at Chicago from two data sets. Investigators used independent t-tests, chi-squared tests, survival analysis, analysis of frequencies, and bivariate correlation to ascertain differences in the RAKT and OKT cohorts from January 1, 2009, to December 31, 2018.

Results

The RAKT group was objectively sicker, demonstrated higher proportions of recipients with Black ethnicity, without a college degree, and lower median household income. The RAKT cohort had a markedly lower wait time for kidney transplant (499.5 days vs 822.7 days in OKT). Patients with BMI over 40 in the two groups had no statistically significant difference in length of stay, graft function, or post-transplant outcomes.

Conclusions/Implications

Despite the myriad of disadvantages, the RAKT cohort clinical outcomes were equivalent to OKT in most respects and superior in wait list duration. As rates of obesity and kidney disease increase, wider proliferation of tools with demonstrated efficacy in treating this population support the social contract of health. Community psychology praxis can support communities in advocating for change in the American healthcare system.

Comments

Thank you to the University of Illinois at Chicago, especially Dr. Enrico Benedetti and Dr. Howard Gordon, for their unwavering support of this research.

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