Thursday, October 17, 2019

Disparity Persists In Kidney Transplantation for Hispanics and African Americans

For two decades now, there has been a campaign to increase the number of Hispanic and black patients receiving kidney transplants from related and unrelated living donors. Recent studies in the United States have shown that Hispanic and black American patients are less likely to undergo kidney transplants.

A Yale-study published in the Journal of the American Medical Association concluded that minority patients had lower chances of receiving a transplant compared to their white counterparts. The study showed an increase in transplants among white and Asian patients but a reduction in black and Hispanic patients

Kidney transplantation is a renal replacement therapy for patients with end-stage renal disease. Transplants provide a chance for a better quality of life with lowered mortality and morbidity rate. The inconsistencies observed in the kidney transplants include longer time on the transplant waiting list (for the minority groups), low access to live donor kidney transplants, lower graft survival rates, and higher chances of diabetes onset after transplantation.

Documentation done over the decades on this trend in kidney transplantation between African Americans and Caucasian Americans have revealed several contributors to these incidences:

  • Inadequate patient education on the risks and benefits of transplants and transplantation process.
  • Low socioeconomic status which puts the minority group at the care of doctors less knowledgeable/specialized on organ donation.
  • Low living and deceased kidney donations from the minority groups – This reduces the chances of allocation of donations to the minorities.
  • Poor health insurance.
  • Patient preferences – It looks into the options of a patient to remain on dialysis or undergo a transplant. Other concerns include a higher pill burden, fear of surgery, and organ rejection.

In 2014, the kidney allocation system was set up to moderate the racial disparity in transplant rates. The problem the system looked into was on access for all to the waiting list. But Professor Sunjay Kulkarini (involved in a Yale study on the subject) revealed that the waiting time wasn’t keenly looked into. 

The waiting list categorizes people in an “inactive” or “active” status. The status of a patient indicates whether a patient is ready to receive a transplant or not. A patient listed as status 7 in the waiting list indicates them as temporarily inactive. This could be attributed to medical problems, out of date medical records (i.e., patients require additional testing), and financial issues. 

 A majority of the Hispanic and black American patients were considered to be in an inactive status, and most in that status were less likely to become active again. 

A study by Erich Greene revealed that an inactive status reduces the chances of a patient to receive kidneys from living donors. Among the solutions arrived to mitigate this condition was that transplant and dialysis centers come together to increase the access of transplants. This so far has been hampered by the reality that private organizations do these practices with an incentive to get profit, thus not likely to cooperate.

In the United States, it’s estimated that there are more than 700,000 patients diagnosed with end-stage kidney disease. 

Nelson O. Freytes
Nelson O. Freytes
Nelson received a liver transplant over 20 years ago due to fulminant liver failure, caused by thyroid medication. A few years after his transplant, Nelson set out to build a ‘next-level’ social network for the transplant community and started Transplant Cafe, and most recently Transplant News.

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