{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T05:44:41Z","timestamp":1791783881982,"version":"4.3.4"},"reference-count":56,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T00:00:00Z","timestamp":1791676800000},"content-version":"vor","delay-in-days":10,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Transplantation"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Black children in the US with ESKD experience higher mortality, lower transplant rates, and longer time on dialysis than other children. Prior research on health disparities in adult kidney patients often emphasizes patient\u2010level psychosocial factors, yet little is known about how providers understand these inequities for children. This study explored pediatric dialysis and transplant social workers' explanations for racial disparities affecting US black children in kidney transplant access.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Semi\u2010structured interviews were conducted with 16 pediatric dialysis and transplant social workers from across the US. Participants were recruited through professional listservs and direct outreach to pediatric nephrology programs. Interview transcripts were analyzed using thematic analysis informed by ecological systems theory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four primary themes emerged: lack of resources, family composition, distrust, and systemic racism. The barriers to transplant that black children face are not limited to the patient\u2010level microsystem as previously described in the literature but rather persist across all ecological system layers. Social workers identified microsystem level barriers as having mesosystem level impact when provider bias leads to judgment about transplant readiness. Social workers named systemic racism as a barrier that transcends all levels of the ecological system, from microaggressions to provider bias to race \u201ccorrections\u201d in clinical algorithms to white supremacy to the legacy of slavery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Findings suggest that transplant evaluation processes may reinforce structural racism. Unlike prior studies emphasizing patient\u2010level explanations, participants identified healthcare systems as key contributors to inequity. Further research should seek the voices of black patients and identify interventions to improve equity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/petr.70492","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T04:46:36Z","timestamp":1791780396000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["\u201cI Think It's Institutional Racism:\u201d Pediatric Social Workers' Explanations of Racial Disparities in Kidney Transplant Access for Black Children in the United States"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5185-2695","authenticated-orcid":false,"given":"Kristin L.","family":"Stockard","sequence":"first","affiliation":[{"name":"University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5760-0371","authenticated-orcid":false,"given":"Chelsea K.","family":"Brown","sequence":"additional","affiliation":[{"name":"University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5104-4332","authenticated-orcid":false,"given":"Teri","family":"Browne","sequence":"additional","affiliation":[{"name":"University of South Carolina  Columbia South Carolina USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4660-8009","authenticated-orcid":false,"given":"Tamara J.","family":"Cadet","sequence":"additional","affiliation":[{"name":"University of Pennsylvania  Philadelphia Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,11]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136\u2010018\u20101789\u20104"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2016.207"},{"issue":"7","key":"e_1_2_10_4_1","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1681\/ASN.2021071020","article-title":"Transplantation Mediates Much of the Racial Disparity in Survival From Childhood\u2010Onset Kidney Failure","volume":"33","author":"Becerra A. 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