Correcting a Longstanding Racial Bias in Kidney Transplant Eligibility

Jazmin Evans, a 29-year-old Philadelphia resident, faced a staggering revelation when her hospital informed her that due to a racially biased organ test, she should have been on the kidney transplant list four years earlier than her actual listing in 2019. This realization came as part of a significant effort to address racial inequities in organ transplantation. As a result, over 14,000 Black kidney transplant candidates, including Evans, received adjustments to their waiting time, boosting their chances for a transplant.

This corrective measure addressed the flawed use of a kidney function test, which falsely indicated healthier kidney function in Black individuals due to a race-based formula. This discrepancy often delayed necessary diagnoses and transplant evaluations, further aggravating existing disparities in healthcare. This race-based approach in medicine has historically skewed various diagnostic tools and treatment guidelines, disadvantaging people of color.

In response to this inequity, the National Kidney Foundation and American Society of Nephrology advocated for race-free calculations in assessing kidney function. The U.S. organ transplant network subsequently mandated the use of race-neutral test results for new transplant candidates. This led to the network's unprecedented decision to retrospectively adjust the waiting times of Black candidates who might have been listed sooner without the biased test.

Since January 2023, over 14,300 Black kidney transplant candidates have had their waiting times adjusted, averaging an increase of two years. More than 2,800 of these candidates, including Evans, have since received transplants. Dr. Martha Pavlakis of Beth Israel Deaconess Medical Center describes this move as an act of restorative justice.

This issue is part of a broader problem in healthcare, where various medical algorithms and formulas include racial or ethnic adjustments that disadvantage minorities. Despite these challenges, change is underway, with several medical bodies removing race from their risk calculators and treatment guidelines.

The initiative to remedy past wrongs in the kidney transplant saga represents a critical step toward restoring trust in the healthcare system and addressing unfair outcomes faced by Black individuals and other people of color. It also serves as a call to action for more inclusive and equitable healthcare practices.