Since 1999, a race-based test has kept thousands of Black people from being appropriately placed on the kidney transplant list. A concerning practice that is shedding light on the systemic bias deeply entrenched within the healthcare system.
Black Americans are over three times more likely than white people to experience kidney failure. Of the roughly 89,000 people currently on the waiting list for a new kidney, about 30% are Black.
Furthermore, controversy revolves around eGFR (estimated glomerular filtration rate), a pivotal metric for evaluating kidney health by measuring the rate at which waste compounds are filtered from the blood.
The equation used to calculate eGFR incorporated a race-based adjustment, resulting in Black patients’ kidneys appearing better functioning than they truly were. This discrepancy, fueled by outdated studies and erroneous theories, led to delayed diagnoses of organ failure and evaluation for transplants, exacerbating existing disparities within the healthcare system.
A couple of years ago, the National Kidney Foundation and American Society of Nephrology urged laboratories to transition to equations for calculating kidney function that do not incorporate race. Subsequently, the U.S. organ transplant network mandated hospitals to exclusively rely on race-neutral test results when adding new patients to the kidney waiting list.
Dr. Martha Pavlakis of Boston’s Beth Israel Deaconess Medical Center and former chair of the network’s kidney committee said, “The immediate question came up: What about the people on the list right now? You can’t just leave them behind.”
Between January 2023 and mid-March, over 14,300 Black kidney transplant candidates saw their wait times modified, with an average delay of two years, according to data from the United Network for Organ Sharing (UNOS). The ramifications of this systemic bias are profound, as Black patients, who are already at heightened risk of needing a new kidney, are now further disadvantaged in their pursuit of equitable healthcare.
The notion of race, a social construct, found its way into medical calculations, perpetuating injustice and hindering access to critical medical interventions. It’s important to note that not every Black kidney candidate was affected by this bias, yet the repercussions of the race-based eGFR adjustment have been far-reaching.
Race-biased testing is a problem that persists throughout the entire healthcare industry. Due to the widespread integration of these practices into medical software and electronic records, many physicians may even lack awareness of it’s significant influence on their patient care decisions.
“Health equity scholars have long been sounding the alarm regarding the inappropriate use of race in clinical algorithms,” Dr. Michelle Morse, New York City’s Chief Medical Officer said.
Despite the systemic hurdles, there have been glimmers of hope. Thanks to the tireless efforts of transplant center staff-turned-detectives, who painstakingly combed through years-old records, some Black patients might finally receive the transplants they urgently needed.
As the healthcare community continues grappling to make things right, it is imperative to address the root causes of racial bias in medical testing and ensure that all patients, regardless of race, receive fair and equitable treatment.
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