This document discusses health disparities faced by racial and ethnic minority populations in the United States. It provides an overview of programs at the Cleveland Clinic aimed at addressing multifaceted health disparities. It highlights that racial and ethnic minorities experience higher rates of disease and poorer health outcomes for conditions like cancer, heart disease, stroke, diabetes and kidney disease when compared to white populations. The document also discusses social and economic factors that contribute to these disparities.

1. Charles Modlin, M.D., MBA
Overview & Examples
Health Disparities in
• Staff Urologist Racial/ Ethnic Minority
• Kidney Transplant Populations
Surgeon
Discuss Causes of
• Founder & Health Disparities
Director, Minority
Men’s Health Health Disparities
Center Prevention
• Cleveland Clinic
Highlight Cleveland
Clinic Programs
Designed to Address
Multifaceted Health
Disparities

2. Disclosures
• I do not have any significant financial
interest or other relationship with the
manufacturers of any products or
providers of services I intend to
discuss.
•

3. Cleveland Clinic
Minority Men’s Health Center

4. Cleveland Clinic Minority Men’s
Health Center/ Health Fair
Established 2003
Special Health Concerns in
Minority Males

5. Health
• In 1947, The World Health Organization
defined health as:
• “a state of complete
- physical,
- mental, and
- social well-being and
- not merely the absence of disease and
infirmity”

6. U.S. Minorities Increasing in
Numbers & Percentage Population
• Minorities:
- African Americans (Blacks), AA
- Hispanic/ Latinos, H/L
- Asian, A
- Native American, (American Indians), NA
- Pacific Islander, PI
• 1970: All U.S. Minorities 12.3% population
• 2003: All U.S. Minorities 25%
• 2006: All U.S. Minorities 30%
• 2050: Projected 50%

7. Population of the United States by Race and
Hispanic/Latino Origin, Census 2000 and 2010
Census Census
2010, Percent of 2000, Percent of
Race and Hispanic/Latino origin population population population population
Total Population 308,745,538 100.0% 281,421,906 100.0%
Single race
White 196,817,552 63.7 211,460,626 75.1
Black or African American 37,685,848 12.2 34,658,190 12.3
American Indian and Alaska Native 2,247,098 .7 2,475,956 0.9
Asian 14,465,124 4.7 10,242,998 3.6
Native Hawaiian and other Pacific
481,576 0.15 398,835 0.1
Islander
Two or more races 5,966,481 1.9 6,826,228 2.4
Some other race 604,265 .2 15,359,073 5.5
Hispanic or Latino 50,477,594 16.3 35,305,818 12.5
NOTE: Percentages do not add up to 100% due to rounding and because Hispanics may be of any race and are therefore counted
under more than one category.
Source: U.S. Census Bureau: National Population Estimates; Decennial Census.
Read more: Population of the United States by Race and Hispanic/Latino Origin, Census 2000
and July 1, 2005 — Infoplease.com http://www.infoplease.com/ipa/A0762156.html#ixzz1yins01sM

8. Race in Medicine & Research
• Active debate about meaning, importance
• Possibility of improving prevention and
treatment of diseases by predicting hard-to-
ascertain factors on the basis of more easily
ascertained characteristics
• Race: surrogate marker of increased
likelihood of certain medical conditions

9. Health Disparities in AA’s
• Compared to general
population, each year:
• 44% more AA’s die from cancer
• 30% more die from heart
disease
• 180% more die from stroke
http://www.cdc.gov/cancer/dcpc/data/race.htm
http://www.kff.org/minorityhealth/index.cfm

10. African Americans Life
Expectancies
• AA’s 6-8 year shorter life expectancy
than whites
• AA’s have not benefited equally from
medical advances
• AAs economically advantaged do not
enjoy in equal measure with whites
expected +++ influence of affluence on
their health.

11. Life Expectancy at Birth (in
years), by Race/Ethnicity, 2007
U.S. Ohio
White 78.7 78.0
AA 74.3 73.3
H/L 83.5 80.4
Asian 87.3 83.4
NA 75.1 NSD

12. Life Expectancy at Birth Among Black and White Males and Females in the
United States and the Black-White Life Expectancy Gap, 1975-2003
Harper, S. et al. JAMA 2007;0:297.11.1224-1232.
Copyright restrictions may apply.

13. Number of Deaths per 100,000
Population by Race/Ethnicity,
2005
United States Ohio
• White 785.3 White 850.4
• Black 1,016.6 Black 1,078.1
• Other 476.5 Other 291.2
2008
United States Ohio
White 750.3 White 828.0
Black 934.9 Black 1,029.2
Other 445.8 Other 325.7

14. Infant Mortality Rate (Deaths per 1,000 Live
Births) by Race/Ethnicity
2003-2005
• United States Ohio
• Non-Hispanic White 5.7 6.4
• Non-Hispanic Black 13.6 15.6
• Hispanic 5.6 6.5
• 2007 Non-HW NH-Black Hispanic
• United States 5.7 13.4 5.5
• Ohio 6.4 15.3 6.6

15. Number of Deaths Due to Firearms
per 100,000 Population by
Race/Ethnicity, 2005
• United States Ohio
• White 8.9 White 7.7
• Black 19.4 Black 22.3
• Other 4.1 Other NSD
http://www.statehealthfacts.org/comparebar.jsp?ind=115&cat=2&sub=32&yr=63&typ=3

16. High Blood Pressure Levels Vary
by Race and Ethnicity
Race of Ethnic Men Women
Group (%) (%)
African
43.0 45.7
Americans
Mexican
27.8 28.9
Americans
Whites 33.9 31.3
All 34.1 32.7
http://www.cdc.gov/bloodpressure/facts.htm

17. Hypertension
African Americans
• HTN risk factor for:
- Kidney, eye, heart, vascular disease
- 7.5 million Blacks
- High salt diets, urban living, poverty,
psychosocial factors: stress, genetic
predisposition
- Greater likelihood of being untreated

18. Cardiovascular Disease and
Heart Failure in AA’s
• CVD leading cause of death in all U.S.
pts.
• Greater incidence in AA’s
• Race and ethnicity influence a patient's
chance of receiving many specific
procedures and treatments:
- AA 13% less likely to have coronary
angiography, 1/3 less to have bypass

19. Screening & Treatment
Differences by Race & Gender
• Blacks are less Paula A. Johnson, MD,
likely to receive MPH
major procedures Brigham and Women’s Hospital
diagnosing and
treating coronary
Sources: Schulman KA et al,
heart disease than N Engl J Med 1999;340(8);
whites Ayanian JZ et al, JAMA,
• Black women are 1993;269,20; Giles et al,
the least likely to Arch Intern Med
have such 1995;155(3); Johnson PA
procedures et al, Ann Intern Med
recommended 1993;119(8))

20. Heart Disease in AA
• Heart failure from HTN is > in Blacks (40%) than
Whites (7%).
• Major risk factors: smoking, HTN, high
cholesterol, physical inactivity.
• AA’s:
- less knowledge about risk factors than whites,
even per age and education.
• AA diet consumption of meat, fried foods, high in
cholesterol and saturated fats.
• Physician Decision-making

21. Cerebrovascular Disease in AA
• Blacks higher incidence of and
>>mortality from stroke than whites
- Blacks more hemorrhagic vs.
ischemic (Stroke 1991^22:299-304)
• Race and ethnicity influence a patient's
chance of receiving many specific
procedures and treatments.

22. 2005 Stroke Death Rates per
100,000 population
(Kaiser Family Foundation)
United States Ohio
Rate
White White
44.7 48.2
Black Black
65.2 60.3
Other Other
38 31.9

23. Cancer in African Americans
• Cancer 2nd leading cause of U.S.
deaths
• AA’s highest death rates in U.S.
• Contributing factors: Tob,
occupations, diet, knowledge, attitudes
and practices, health/medical
resources, biological factors,
socioeconomic status.

24. Smoking in African
Americans
• AA tend to start smoking later in life
and fewer cigarettes/day than Whites
• More likely smoke Tar and Nicotine
brands, 55% AA use only mentholated
form
• AA less likely than Whites to quit
• AA 30% higher Nicotine intake per
cigarette and differ in metabolism
• Clin Immunol Immunopathol. 1991 May;59(2):187-200.

25. Cancer in AA
 By Race, AA more likely develop and
die of the 4 most common cancers:
 Breast,
 Prostate,
 Colon,
 Lung—
 Cancer Incidence and Death Rates* by Site, Race, and
Ethnicity†, US, 2004-2008. American Cancer Society. Cancer
Facts & Figures 2012. Atlanta: American Cancer Society;
2012.

26. Cancer Incidence Rates by Race
(Kaiser Family Foundation)
2004 Rate Age-Adjusted per 100,000
• United States Ohio
• White 455.4 White 426.1
• Black 469.6 Black 453.6
• Hispanic 356.5 Hispanic 403.7
0.0 - 471.7
United States Rate
White 462.5
Black 471.7
Hispanic• 350.1
•
2007

27. Number of Cancer Deaths per
100,000 Population by
Race/Ethnicity, 2005 & 2007
U.S. 2005 2007 Ohio 2005 2007
White 182.6 174.7 Whites 194.2 190.5
Black 222.7 209.1 Blacks 249.2 238.1
Other 112.4 108.5 Other 66.0 91.3

28. Cancer Mortality Trends Among
Men by Race/Ethnicity: Progress
Among white men in the • Among black men in the
United States from 1999 to United States from 1999 to
2008, deaths from— 2008, deaths from—
- Colorectal cancer - Colorectal cancer
decreased significantly decreased significantly
by 3.0% per year. by 1.9% per year.
- Lung cancer decreased - Lung cancer decreased
significantly by 2.0% significantly by 2.8%
per year. per year.
- Prostate cancer - Prostate cancer
decreased significantly decreased significantly
by 3.4% per year. by 3.7% per year.
- Melanoma of the skin - Melanoma of the skin
increased significantly remained level.
by 1.0% per year.

29. Five-year relative survival by stage at diagnosis for
total cancers
in adults 20 years and older by race and gender
Source: SEER 1992-2001
Stage at
diagnosis Local Regional Distant All Stages
Distant All stages
Gender Race Diagnosed % Survival %Diagnosed % Survival % Diagnosed % Survival % Survival %
Men Black 54 92 20 31 26 16 56
White 58 95 20 43 22 20 64
Women Black 40 83 33 50 27 15 51
White 50 92 28 61 22 21 64
Local

31. Lung Cancer Deaths
Total Population
Rate per 100,000
TOTAL 57.6
Race and ethnicity
American Indian or Alaska Native 38.2
Asian or Pacific Islander 29.3
Asian DNC
Native Hawaiian and other Pacific Islander DNC
Black or African American 66.7
White 57.5
Hispanic or Latino 22.7

32. Prostate Cancer Deaths
Males Rate per 100,000
TOTAL 32.0
Race and ethnicity
American Indian or Alaska Native 15.9
Asian or Pacific Islander 12.4
Asian DNC
Native Hawaiian and other Pacific Islander DNC
Black or African American 68.7
White 29.4
Hispanic or Latino 20.9
Data source: National Vital Statistics System (NVSS), CDC, NCHS.

33. Number of Diabetes Deaths per
100,000 Population by
Race/Ethnicity, 2005
United States Ohio
• White 22.5 White 28.4
• Black 47.0 Black 58.3
• Other 20.5 Other NSD

34. Kidney Disease and
African Americans
• The incidence of ESRD in AA is 4 times
greater than in whites.
• HTN and DM are the most commonly
identified causes of kidney failure
• National chronic kidney disease fact sheet, 2007.
http://www.cdc.gov/diabetes/pubs/factsheets/kidney.htm

35. New Cases of End-Stage
Total Population
Renal Disease
Rate per Million
TOTAL 289
Race and ethnicity
American Indian or Alaska Native 586
Asian or Pacific Islander 344
Asian DNC
Native Hawaiian and other Pacific Islander DNC
Black or African American 873
White 218
Gender
Female 242
Male 348
Data source: U.S. Renal Data System (USRDS), NIH, NIDDK.

36. Renal Transplantation:
Disparities
• Currently approx.
- 100,000 pts. on Kidney Tx
Waiting list
•35% AA; 19%H/L
•But AA’s only 12% U.S.
population; H/L 16%
• NIH News
http://www.nih.gov/news/health/mar2012/niddk-08.htm
• AA only get 26% of Deceased
Donor Kidney Tx

37. Renal Transplantation:
Disparities
• Among Appropriate Candidates for Tx, Blacks
are less likely: (UNOS Scientific Registry)
- referred for evaluation
- listed for Tx (account for only 28% new
listing)
- receive Tx
- Post Tx have higher rejection rates (50%
higher), lower patient and graft survival
Blacks wait 2-4 times as long as whites

38. Why Healthcare Disparities?
• Reasons:
• Multifactorial
• Patient and Provider Factors
• Culture/ Culture Competency/ Communication
• Education/ Health Literacy
• Historical Factors/ Distrust/ Racism/ Stereotyping/ Bias
• Socio-Economic
• Lack of health insurance
• Lack of Access
• Environment/ Nutrition
• Lack of Diverse Healthcare Workforce
• Genetics/ Biologic/ Diff. Response to Medications
• Lack of Minority Patients in Research Trials
• Sub-specialization in Medicine & Lack of Awareness of
Disparities

39. Health Disparities Solutions:
Multifaceted
- Based upon our Cleveland
Clinic MMHC Observations
and Research
- Examples of our Cleveland
Clinic Innovative Solutions/
Programs

40. Solutions: Step 1
Health Provider Recognition,
Acknowledgment of Existence,
Causes & Impact of Health Disparities
in Minority Populations

41. Doctors on Disparities in Medical
Care
• Doctors less likely than public to say
disparities are happening “very often”
or “somewhat often.”
• Kaiser Family Foundation Survey, March
2002. http://www.kff.org/minorityhealth/20020321a-index.cfm

42. Health Provider Education
• Regarding:
- Existence and Impact of
Health Disparities in
Minority Populations

43. Congressman Louis Stokes
Health Equity Lecture Forum,
Established 2006

44. Cleveland Clinic Journal Medicine
Special Series 2012:
Addressing Disparities in Health Care
Guest Editor: Charles Modlin, MD, MBA
• Modlin CS.
Addressing
Disparities in Health
Care Cleveland Clinic
Journal of Medicine
January 2012 vol. 79
(1): 44-45.

45. Disparities in prostate cancer in African American
men: what primary care physicians can do.
Wu I, Modlin C. Cleveland Clinic Journal of Medicine
May 2012 vol. 79 5 313-320

46. SOLUTION: Step 2
Vision & Commitment
Institutional/Self-Belief that You
Can Make A Difference

47. Solutions: Step 3:
Health Provider Cultural Competency &
Sensitivity
• All providers need to become sensitive
to traditions, values, attitudes of ethnic
groups
- Mandated in some states, i.e. New
Jersey first state
• Cultural sensitiveness indicates how
culture can strongly influence the amount
and type of communication between
patients and their health providers

48. The African American Barber Shop, Beauty Salon
and Church Initiative
A Tool in Development of Medical & Nursing
Student & Health Provider
Cultural Competency/Sensitivity

50. Step 4: Community Trust-Building
• Key Lesson:
Initiative
Barbershop, Salon, Church
• Trust is single most important
prerequisite necessary for healthcare
providers to have success in promoting
health in AA communities.

51. Solutions: Step 5
African American Physician Leadership,
Visibility & Availability:
Very Important To The African American Community

52. Become Part of the Community:
Build Trusting Relationships

53. Become Part of the Community:
Build Trusting Relationships

54. TEAMWORK & VOLUNTEERISM:
Step 6
• Dept. Urology
• Dept. Nephrology
• Medicine Institute
• Cleveland Clinic
Interdepartmental Clinical
Collaborations
• Wellness Institute
• Dept. Pastoral Care Services
• Dept. Social Work
• Pharmacy
• Division of Nursing
• Nutrition Services
• Institutional Services (Pt.
Education, OPSA, Sponsored
Research, etc.)
• Corporate Communications
• Governmental & Community
Relations
• Diversity
• Bioethics
• Biostatistics
• Cleveland Clinic Lerner College
of Medicine
• Lerner Research Institute

55. Community & Corporate
Partners and Sponsors: Step 7

56. Solutions: Step 8
• Facilitated Patient Access
• Financial/ Charity Assistance Programs

57. Cleveland Clinic
Financial Assistance Program
• Under Ohio Hospital Care Assurance Program (HCAP)
Cleveland Clinic offers basic, medically necessary
hospital-level services free of charge to individuals who
are residents of Ohio, and who are currently eligible
recipients of the General Assistance or the Disability
Assistance Programs or whose income is at or below the
Federal Poverty Income Guidelines.
• In addition, Cleveland Clinic provides financial
assistance on a sliding scale to patients who do not have
insurance at family income levels up to four (4) times the
Federal Poverty Income Guidelines, and to all patients,
including patients with insurance coverage, if there are
exceptional circumstances.

58. Financial Assistance Program
Family Size HCAP 2008 CC Financial
Federal Assistance
• 2008 Federal Poverty
Income Level
Program
(Family Income
up to 400% of
Poverty Income Federal Poverty
Level)
Guidelines
1 $10,400 $41,600
2 $14,000 $56,000
3 $17,600 $70,400
4 $21,200 $84,800
5 $24,800 $99,200
6 $28,400 $113,600
7 $32,000 $128,000
8 $35,600 $142,400

59. Facilitated Patient Access:
Step 9: Preventive Health
Screenings & Health Education

60. “Every Life Deserves World Class Care”

61. 10th Annual Minority Men’s
Health Fair

62. Health Fair Video
• Courtesy Mr. Greg Lockhart
- Frame By Frame Video
Productions
http://www.youtube.com/watch?v=3L4zEnecs9M

64. Health Screenings: Identification of
Diseases in Early Treatable States

65. MMHC Health Fair Screenings 2007
600
500
422 439
400
400
e
l
t
i
T 300
s
i
217
x
A
200
200
153
120
100
0
Dental Screenings Blood Pressure Stress Urinalysis Reviewed DRE Blood draws
& Oral Hygiene Screening Management Medications
Instruction
Series1 120 153 200 217 400 422 439

70. Solutions: Step 10: Dedicated
Health Literacy Education
• Health Education/ Outreach
to Promote/ Improve Health
• Health Literacy
Literacy
Saves Lives
- Increase awareness of
preventive health
- Increase health
screenings
- Promote healthy
lifestyles
- Promote participation
in clinical trials by
minorities
- Promote awareness of
family medical history

71. Minority Men’s Health Center
Health Fair
Health Information You Need To
Know!
(With Pre & Post Test Options)

72. Kidney Disease and Kidney
Transplantation
• Diabetes and high-blood pressure
cause most kidney disease and kidney
failure.
• Control of your blood pressure and
blood sugar may prevent kidney
disease.
• Kidney transplantation is a way to treat
kidney failure. More AA are needed to
donate their kidneys while living or
after death.

73. Diabetes
• Risk factors for diabetes are:
- Genetics
- Obesity
- Lack of exercise
- Other predisposing factors

74. Solution: Step 11:
Communications
Health Disparities Public Media Campaign
• TV Media/ News
• Print Media

75. Media Awareness

76. Solutions: Step 12
Patient Compliance:
How To Improve It

78. Solutions: Step 13
Community Empowerment:
Cleveland Clergy Ambassadors
Health Education Program

79. 2012 Minority Men’s Health Center
Health Advocates

80. Solutions: Step 14
Translational Medicine to Benefit
Health Disparity Populations

81. Solutions: Step 15
Encourage Minority Patient
Participation in Clinical
Research Trials

82. Response to Medications
African Americans
• Differences in genetics, environmental and cultural
factors may lead to racial differences in response to
medications.
• Studies and Examples:
• AA respond better to Calcium Antagonists
- Whites respond better to ACE and B-Blockers
- BiDil—New Med to treat CHF in AA
- RACE-BASED MEDICINE
- Immunosuppressive Medications in AA

83. Etiology of Heart Failure
in Black Patients
HTN CAD
LVH MI
HF
More common cause More common cause of
of HF cases in blacks HF cases in whites
LVH=left ventricular hypertrophy.
Adapted from Yancy CW. J Card Fail. 2003;9(suppl 5):S210-S215.

84. A-HeFT: Additional 43% Reduction in Mortality Beyond Current
Standard Therapies
100
BiDil + Standard Therapies
95
Survival (%)
90 Placebo + Standard Therapies Event rate=6.2%
43% Reduction*
P=.012 by Log-Rank Test
85 Event rate=10.2%
0 100 200 300 400 500 600
Time (days)
BiDil, n = 518 463 407 360 314 253 16
Placebo, n = 532 466 401 340 285 233 25
*Reduction refers to relative risk in mortality 1 – (hazard ratio) =1 – 0.57 =0.43. Reduction represents full length
of follow-up.
BiDil [prescribing information]. Lexington, MA: NitroMed, Inc.; 2005.

85. Solutions:
Step 16: Mentorship: Developing
Future Healthcare Leaders

86. Increasing Diversity of Health
Provider Workforce

87. Solutions: Step 17:
Develop Community Partnerships

88. Community Leadership &
Celebrity Endorsement of
MMHC: Step 18

89. Bill Cobbs: Hollywood Actor
on Disease Prevention & Early Detection
• http://www.youtube.com/watch?v=-HE7I_J-q98&featu

90. Health Policy Advocacy:
Step 19:
United States Congressional Black Caucus,
U.S. Capital,
Washington, D.C.

91. Healthy People 2000: Priority Areas
• 1. Physical Activity and Fitness
2. Nutrition
3. Tobacco
4. Substance Abuse: Alcohol and Other Drugs
5. Family Planning
6. Mental Health and Mental Disorders
7. Violent and Abusive Behavior
8. Educational and Community-Based Programs
9. Unintentional Injuries
10. Occupational Safety and Health
11. Environmental Health
12. Food and Drug Safety
13. Oral Health
14. Maternal and Infant Health
15. Heart Disease and Stroke
16. Cancer
17. Diabetes and Chronic Disabling Conditions
18. HIV Infection
19. Sexually Transmitted Diseases
20. Immunization and Infectious Diseases
21. Clinical Preventive Services
22. Surveillance and Data Systems

92. Healthy People 2010
• Healthy People 2010 challenges individuals, communities,
professionals, and institutions—all of us— to take specific
steps to ensure that good health, as well as long life, are
enjoyed by all.
•
Healthy People is managed by the
Office of Disease Prevention and Health Promotion,
U.S. Department of Health and Human Services

93. Step 20:Promotion of & Celebration
of Family Support Systems and
Awareness of Family Medical History

94. Solutions: Step 21
Outcomes Research
• Look at health outcomes in your own
practice and at your own institution
• Know how you are doing
• Develop strategies to improve your
outcomes

95. Analysis of Disparities in Kidney
Transplantation by Race at
Cleveland Clinic
Section of Renal Transplantation
Minority Men’s Health Center
C. Modlin, C. Zaramo, J. Alster, L. Zhou, D.
Goldfarb, S. Flechner,
and A. Novick

96. Health Disparities in Renal Graph
Survival in Tx Patients by Race and
Source of Allograft
Cadaveric (CAD) Living Related (LR)

97. Dialysis 1st Week Post-Tx
Significant Disparities in Dialysis following the First
Week of Post Renal Transplantations (Post-Tx, p<0.001*)
100
*p< 0.0001
Percentage (%)
80
52.14%
60
40 15%
20 8.16% 5.14%
0
African Caucasian African Caucasian (L)
American (CAD) (CAD) American (L)
Race/ Ethnicity

98. Post-Tx Serum Creatinine (CAD)
Creatinine Levels from Cadaveric Donors, Significant Difference at 7
Days
(p<0.0001), 1 month (p=0.005) and 2 Months (1 Year ) (p< 0.004)
*
7
African American (CAD)
p=0.0001
White (CAD
6
5
P<.0001 @ 7 days
P<.008 @ 12 mos.
4
3
* p=0.005
2
1
* p=0.004
0
Day 7 1 3 6 12 36
Time

99. STEP 22:
Putting it all together:
Develop and Implement
Multifaceted Innovative
Programs to Address Health
Disparities

100. • Transplantation
Proceedings
Volume 40, Issue 4 ,
Pages 1001-1004, May
2008

101. Culturally Sensitive & Competent Team to
Promote Organ Donor Registration

102. Expanding Organ Donation
Acceptance and Transplant
Rates in African Americans
AND
Promotion of Prevention of
Kidney Disease in African
Americans

103. Solution: Promotion of Living
Kidney Donation in African
Americans

104. Living Unrelated Renal
Transplantation
• http://www.youtube.com/watch?v=jy0CsHLL8YE

105. Living Related Renal
Transplantation

106. Standard Surgical Techniques
for Kidney Transplantation

109. Renal Allograft

111. Solutions:
Innovations in Healthcare:
Look to see how you can innovate
to improve outcomes
• Utilization of Expanded Criteria Donor Kidneys for
Transplantation:
- Single Pediatric Deceased Donor Allografts
- Pediatric Enbloc Deceased Donor Allografts
- Kidneys with multiple arteries
- Dual Deceased Donor Allografts
- Kidneys with capsular injuries
- Kidneys with renal artery aneurysms

112. Expanded Criteria Donor
Kidneys for Transplantation
• Modlin CS,
Goldfarb DA, Novick
AC. The use of
expanded criteria
cadaver and live
donor kidneys for
transplantation. Urol
transplantation
Clin North Am. 2001
Nov;28(4):687-707.

113. Issues and Techniques Available to Expand
the Pool of Kidneys Available For
Transplantation. MODLIN
• Chapter 10. In Kidney
and Pancreas
Transplantation: A
Practice Guide.

115. Multiple Renal Arteries

116. End-To-Side Arterial
Anastamosis

117. Dual Mate Kidney with 3 Arteries

118. Dual Mate Kidney with 4 Arteries

119. Dual Deceased Donor Allograft

121. Pediatric Deceased Donor
Kidneys For Transplantation
• Modlin C, Novick AC, Goormastic M, Hodge E,
Mastrioanni B, Myles J. Long-term results with single
pediatric donor kidney transplants in adult recipients. J
Urol 1996 Sep;156(3):890-895.
• Hobart MG, Modlin CS, Kapoor A, Boparai N, Mastroianni
B, Papajcik D, Flechner SM, Goldfarb DA, Fischer R,
O'Malley KJ, Novick AC. Transplantation of pediatric
enbloc cadaver kidneys into adult recipients.
Transplantation 1998 Dec 27;66(12):1689-1694.

122. Pediatric Enbloc Allografts

123. Pediatric Enbloc Kidneys

126. Pediatric Enbloc Kidney
Allografts

127. Pediatric Enbloc Allografts

128. Pediatric Enbloc Post Perfusion

129. Capsular Repair Vicryl Mesh

130. Capsular Repair

131. Renal Capsular Repair
• J Natl Med Assoc.
2012;104:199-201

132. Renal Angiomyolipoma
in Living Donor Kidney

133. Living Donor Kidney with
Renal Artery Aneurysm