Meet LaQuayia “LQ” Goldring, standing at the precipice of hope and disappointment, expecting a kidney transplant. The organ transplant panel is re-evaluating the influence of an inherently racially prejudiced key element that maps her priority on the waitlist. Though sounding promising, it lay bare a harsh truth, indicating several lost years.
LaQuayia has crossed a road full of thorns, suffering from kidney disease from a very tender age. The pendulum of life swung between a lost left kidney to a rare cancer, starting renal failure in her teenage, leading to a kidney transplant, and eventually failing again. With the haunting return of kidney disease, LaQuayia was back on the waitlist at the age of 25.
Sharing a similar fate with LaQuayia are over 103,000 people in the United States, registered on organ transplant waitlists. The unpredictable waiting tenure spans from days to years, with variables of health conditions, organ unavailability, and the compatibility of the patient with a donor.
The Disproportionate Demographics
The organ necessities outstrip its availability. The gravitational racial disparities become more explicit in the organ allocation. The reports by the Office of Minority Health illustrates that amongst the patients on the waiting list, Black patients witnessed less prioritization than White patients. Statistics show that in comparison to 47% of White patients, only 28% of Black patients received transplants in 2021.
However, it’s essential to note that race doesn’t solely drive the allocation process. Multiple intertwined factors play a role. The minority races encounter more significant bottlenecks from the episode of organ failure till receiving the transplant, and sadly, some never achieve it. Charles Beardan, the veteran organ recovery/transplant coordinator, and his inputs to the 2022 report on organ transplant system disparities underscore this harsh reality. The report unearths the undeniable social disparities in the organ transplant system, putting some groups, and most disadvantaged being the minorities, at a lower end.
For instance, the National Kidney Foundation suggests that Black patients on the kidney transplant list averagely have to wait a year longer than White patients for receiving a kidney transplant.
The Forward Momentum In Organ Transplant
Solutions might not be simple or instant, but the strides are significant. Critical aspects including data and inequalities have placed the U.S. organ transplant program, majorly run by the nonprofit United Network for Organ Sharing (UNOS), under stringent Congressional and Federal scrutiny.
In a breakthrough step, the Health Resources & Services Administration (HRSA) in March announced a transformation drive encompassing transplant network strengthening, transparency, and improved equitable access to transplant. The wind has started to flow towards change, but the pressing question remains – is it timely enough for LaQuayia and countless others alike?
Re-evaluating Biases
An essential catalyst in this transformation is the re-examination of the estimated glomerular filtration rate (eGFR) categorizing Black people. This measure of kidney functionality primarily impacts the urgency for a new kidney and the patient’s waitlist standing.
The misinterpreted eGFR calculation grounded on erroneous beliefs that Black individuals possess higher muscle mass than others was flawed. The domino effect was a 16% better kidney function representation for Black patients than White patients, ultimately making their kidneys appear more enduring.
Martha Pavlakis, MD, chair of the Kidney Transplantation Committee for the Organ Procurement and Transplantation Network (OPTN), strongly critiques this racial bias, branding it racist and erroneous. Consequently, it has kept Black patients off the transplant list.
In a remarkable move, OPTN’s tactical objective to ensure access to transplants equitably led to the discontinuation of race utility in patients’ eGFRs calculations by UNOS. The order to revaluate the eGFRs and waiting durations for Black patients has been initiated. Although the transplant centers have until January 2024 to accomplish these recalculations, only a minor shift in positions may occur.
Unseen Challenges
Kidneys lead transplant lists in the U.S., followed by liver, heart, lungs, and pancreas. However, non-medical elements like income, insurance, housing, and transportation often play decisive roles in marking the waitlist. These factors disproportionately burden ethnic minorities, indicating deep-seated systematic inequities require robust examination and overhaul to ensure timely and equitable organ transplantation.
Such a comprehensive modification of the organ transplant system brings cautious optimism closer to becoming a reality. Even though changes are on the horizon, they might seem out of reach for many like Laquayia. Undeniably, healthcare equity remains the need of the hour as we pave the way for a more inclusive future.
