 Title: Culturally tailored behavioral interventions to enhance living kidney donationliving kidney transplantation Applicants: Johns Hopkins Medical Institutions, National Kidney Foundation of Maryland Principal Investigator: Neil R. Powe, MD, MPH, MBA Address: 2024 E. Monument Street, Suite 2-600, Baltimore, MD, 21205 Phone: 410-955-6953; Email: Fax: 410-955-0476 Rates of kidney donation have been largely stagnant for the past 10 years, resulting in large imbalances in numbers of persons on transplant waiting lists and the number of persons receiving kidney transplants. Slow improvement in donation and transplantation rates are exacerbated by ethnicracial disparities in kidney transplants, in which minorities, particularly African Americans, are far less likely to receive deceased kidney transplants. Although living related kidney donation LD offers patients an opportunity to bypass many barriers contributing to disparities in kidney transplantation e.g. waiting lists and immunological incompatibility issues, African Americans remain less likely to receive living related kidney transplants LRT, further exacerbating disparities in transplant rates. Recent research demonstrates many ethnic minorities desire kidney transplantation, but rates of patient-physician and patient-family discussions regarding LDLRT are suboptimal. Compared to Whites, African Americans have also been shown to have disproportionately greater rates of culture-specific concerns such as mistrust in health care that could impede them from seeking important medical therapies. It is unknown whether culturally tailored behavioral interventions to enhance patientfamily decision-making regarding LDLRT before the onset of end stage renal disease could improve rates of LDLRT or could narrow racial disparities in the receipt of transplantation. The primary goal of this proposal is a to use focus group methodology to develop culturally tailored educational materials for patientsfamilies considering LDLRT and b to perform a randomized controlled trial to test the effectiveness of a culturally tailored social-worker led intervention using established behavioral problem-solving therapeutic techniques in enhancing rates of family communication, donor evaluations, and transplantation. The substantial experience of our consortium, including the National Kidney Foundation of Maryland and the Johns Hopkins Medical Institutions Welch Center and the Medical Surgical Transplant Services in the School of Medicine, in the evaluation implementation of donorrecipient educational programs as well as the conduct of behavioral, epidemiologic and interventional studies related to donorrecipient health and psychology provides a strong foundation for the conduct of this study. 