Black People With Kidney Issues Face Barriers, Will Eliminating An Allegedly Racially-Biased Test Help?

Between January 2023 and March 2024, over 14,000 Black people on the kidney transplant list had their positions on the list adjusted because algorithms used by the healthcare industry counted their race against them, something health equity scholars have criticized for decades.

Black people are four times as likely as whites to suffer from kidney failure, but the kidney function of many Black people has been overestimated by “race corrections” that were added to the GFR test and have been criticized as racially biased. 

As The Associated Press reports, advocates like Dr. Michelle Morse, New York City’s Chief Medical Officer, see the adjustments to the kidney transplant list as a long overdue change.

Morse told The AP, “Health equity scholars have been raising alarm bells about the way race has been misused in clinical algorithms for decades. Lots of time when we see health inequities, we just assume there’s nothing we can do about it,” Morse said. “We can make changes to restore faith in the health system and to actually address the unfair and avoidable outcomes that Black people and other people of color face.”

To Morse’s point, approximately 30% of people on the waiting list for a new kidney are Black, and a complex mix of factors have affected their wait times for new kidneys, including a lack of Black transplant doctors and a lack of Black organ donors. 

In 2021, Jewel Mullen, a medical doctor and the Associate Dean at the University of Texas at Austin’s Dell Medical School, wrote an op-ed for the AAMC. Mullen described the experience of a man she treated, using the pseudonym of Mr. Richardson. 

In her conclusion, Mullen stated, “So many disparities in the transplantation system are unfair, avoidable, and unjust. None of us should succumb to a better-than-nothing mindset. Better than nothing is not good enough. Our patients deserve equity.”

Mullen also noted that she was concerned about Richardson’s overall kidney health and wondered if he was receiving proper care from his primary care physician. According to Yale Medicine, diabetes and high blood pressure, two ailments more prevalent in the Black community, can lead to chronic kidney disease.

Mullen was part of a committee that produced a report in 2022, Realizing the Promise of Equity in the Organ Transplanting System, for the National Academies of Science and Medicine. The report laid out how the path to equity, which Mullen called for, was full of problems for those in need of an organ transplant. 

Following the release of the report, in 2023, the Board of Directors of the Organ Procurement and Transplantation Network (OPTN) approved an action to backdate waiting times for Black kidney transplant candidates. Board President Jerry McCauley said in a statement that the action was intended to emphasize OPTN’s desire for equity in the field. 

“This action underscores our commitment to equity in access to transplantation for all candidates,” McCauley said. “We and many other organizations have now prohibited the use of a race-based calculation that has unfairly delayed care for many Black patients with kidney failure. Waiting time for a transplant is a major factor in the priority that kidney candidates receive. Thus, we are acting along with kidney transplant programs nationwide to ensure that any candidates known to have been disadvantaged by a race-inclusive GFR calculation will receive all the waiting time credit for which they qualify.”

Glenda V. Roberts, who works at the University of Washington’s Kidney Research Institute, wrote an op-ed for Stat News in 2021. Roberts, who wrote that she faced a barrier to the transplant system because she identified as Black, expected the elimination of the GFR’s racially biased elements for work in the benefit of Black patients who need transplants.

“Race is a social construct, not a biological one. The National Institute of Health’s Human Genome Project has demonstrated that there are no biological differences between races. Armed with this evidence and the new eGFR recommendation, I expect doctors to ensure that their Black patients with potential kidney disease get true readings of their kidneys’ health and the same level of care and consideration that non-Black patients have received since 1999.”

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