Black Kidney Donations Are Frequently Thrown Away Due to Medical Bias 

Marko Aliaksandr /
Marko Aliaksandr /

Kidney disease poses a significant health challenge in the U.S., disproportionately impacting Black Americans, who have three times the risk of developing kidney failure compared to white Americans. Despite making up only 12% of the population, Black Americans account for 35% of kidney failure cases. This is primarily because of higher rates of diabetes and high blood pressure in the Black community. 

Close to 100,000 people in the U.S. are awaiting kidney transplants. Black Americans are more likely to need these transplants but less likely to receive them.  

The problem arises from an outdated test that wrongly showed Black people’s kidneys as healthier than they truly were. This was due to an automated formula that calculated results differently for Black and non-Black patients. This race-based equation could delay the diagnosis of kidney failure and the evaluation for a transplant, worsening existing disparities that make Black patients more likely to need a new kidney but less likely to get one. 

The U.S. organ transplantation system uses the kidney donor profile index, an algorithm that considers ten factors, including donor age, height, weight, and medical history, including hypertension and diabetes. One of these factors is race. 

The eGFR (estimated glomerular filtration rate) assesses kidney health by measuring how efficiently a waste compound called creatinine is filtered from the blood. Due to an outdated misconception about creatinine levels, lab reports are commonly used to provide separate results for non-Black and Black patients. These reports, until recently, often overestimated kidney function for Black patients by up to 16%. This means that Black kidney failure patients were not eligible for a transplant based on erroneous data regarding their kidney function. 

Further complicating matters, studies on previous transplants indicate that kidneys from Black donors tend to fail sooner than those from other races, lowering the average lifespan of these kidneys. Consequently, the algorithm often downgrades the quality of kidneys from Black donors, leading to higher discard rates. This means some viable kidneys are wasted, creating ethical and practical concerns. 

A few years ago, the National Kidney Foundation and the American Society of Nephrology urged laboratories to switch to race-free equations for calculating kidney function. Subsequently, the U.S. organ transplant network mandated hospitals to use only race-neutral test results when adding new patients to the kidney waiting list. 

While some medical researchers suggest that making organ transplantation fairer could involve disregarding race when assessing donor kidneys, this approach might overlook differences in transplant outcomes. It could potentially lead to transplanting kidneys with genetic issues that increase the risk of premature failure. 

Furthermore, because Black kidney recipients often receive kidneys from Black donors, eliminating race from evaluation could perpetuate existing disparities in transplantation. 

An alternative approach to improve public health and reduce racial health disparities involves identifying factors contributing to higher failure rates in kidneys donated by Black individuals. Researchers are using the APOLLO study, which examines the influence of specific genetic variants on donated kidneys, to identify those at higher risk. 

Specific forms or variants of the APOL1 gene increase the likelihood of developing kidney disease, especially when an individual carries two copies of these variants. While approximately 85% of people with these variants never develop kidney disease, about 15% do.  

Individuals with two copies of the riskier forms of the APOL1 gene typically have ancestry from Africa, particularly West and sub-Saharan Africa, and are often categorized as African Americans. 

Studies on kidney transplantation indicate that kidneys from donors with two copies of the higher-risk APOL1 variants have higher rates of failure after transplant. This discovery could help explain why kidneys donated by Black individuals often fail at higher rates. 

For those Black Americans currently on the waiting list, justice is coming, albeit slowly. The transplant network gave hospitals a year to identify Black kidney candidates who could have qualified for a transplant earlier if not for the race-based test and adjust their waiting times accordingly. This review process is ongoing for newly listed Black patients to determine if they, too, should have been referred sooner. 

From January 2023 to mid-March, the United Network for Organ Sharing, which manages the transplant system, modified the wait times for over 14,300 Black kidney transplant candidates by an average of two years. So far, more than 2,800 of these patients have received a transplant. 

This is a form of reparations every U.S. citizen can support. There is no room for healthcare inequality in America.