Despite changes, the kidney transplant system continues to deal with racial bias

How as we previously reported, the eGFR test was modified following criticism that it affected the ability of potential black kidney transplant recipients to obtain an acceptable place on the kidney transplant list. Now that the test’s evaluation of kidney function has removed the racist corrections, greater than 14,000 kidney transplant candidates have been moved up the list.

It said the bias against black people participating in the test was based on the assumption that the kidneys of black people functioned in a different way from other groups, which Martha Pavlakas, former chair of the kidney committee of the Organ Procurement and Transplantation Network, said was problematic.

“It was really problematic, but it was very widely accepted,” Pavlakis said. “That’s what we were taught. This is what we turned around and taught other people.

One of greater than 14,000 black kidney transplant candidates, Jazmin Evans, describeshe described her feelings in a 2023 Tik-Tok video. Evans was shocked when she was moved to the next level, but she also knows that she shouldn’t have been in that position in the first place.

“My original waiting time started in April 2019.” Evans said in the video. “With the new calculations for Black Americans, my “start date” would start in 2015. At this point, I even have been on the transplant list for eight years. For my blood type, the average waiting time is about 4 to five years. I could have already got a kidney.”

Evans said her story is an illustration of how far the United States must go to achieve equality. “You know, everyone says we live in a post-racial society here in America, but that’s really not true.”

While Pavlakas said there’s a standard belief that the kidneys of black people function in a different way from those of other ethnicities, several advocates have called it inappropriate to consider racial bias in the transplant process.

One of those supporters, Dr. Samira Farouk, a transplant nephrologist and volunteer with the National Kidney Foundation, said “one of the risk factors related to race is racism,” Farouk said.

“So thinking about decreased access to care and decreased access to medications, decreased access to optimal diabetes and control of high blood pressure. “It really goes back to the initial assumption that race is a biological variable (which is not accurate).”

Racial bias permeates the entire kidney transplant system, from kidney profile index calculations to the kidney transplant waiting list, but a vote scheduled for June by the Organ Procurement and Transplantation Network hopes to address inequities in the kidney profile index. Meanwhile, of the 14,280 Black applicants who were moved to the waiting list between January 2023 and March 2024, 3,000 received transplants.

Michelle Josephson, former president of the American Society of Nephrology, said she hopes the transplant system shall be simpler by eliminating racial inequities.

“There are many issues in medicine and many other parts of our culture that speak to our very difficult history. And I think this is one of them,” Josephson said. “The good news is that we have withdrawn from the race and tried to fix some of the bumps that were created because of it.”