Kidney Transplant System Continues To Deal With Racial Bias, Despite Changes

Although Pavlakis said that the belief that Black people's kidneys functioned differently than other ethnic groups’ kidneys was widespread, several advocates described the inclusion of racial bias into the transplant process as inappropriate.

As BLACK ENTERPRISE previously reported, the eGFR test was revamped after criticism that it was impacting the ability of potential Black kidney transplant recipients to receive proper positioning on the kidney transplant list. Now that the test’s analysis of kidney function has removed racially biased corrections, it has resulted in over 14,000 kidney transplant candidates being moved up the list.

As ABC News reported, the bias against Black people present in the test was based on an assumption that Black people’s kidneys functioned differently than other groups, something that Martha Pavlakis, the former chair of the kidney committee of the Organ Procurement and Transplantation Network, says was problematic.

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

One of the more than 14,000 Black kidney transplant candidates, Jazmin Evans, described her feelings in a 2023 Tik-Tok video. Evans was shocked when she was moved up, but she is also aware that this is not a position she should have been in, to begin with.

“My original wait time started April of 2019,” Evans said in the video. “With the new calculation for Black Americans, my ‘start date’ would have started [in] 2015. At this point, I am eight years on the transplant list. For my blood type, the average waiting time is about four to five years. I could’ve [had] a kidney already.”

Evans told ABC News that her story is an illustration of how far the United States has to go to achieve equality. “Everyone says, you know, we live in this post-racial society here in America, but that’s really not the truth.”

Although Pavlakis said that the belief that Black people’s kidneys functioned differently than other ethnic groups’ kidneys was widespread, several advocates described the inclusion of racial bias into the transplant process as inappropriate.

One of those advocates, Dr. Samira Farouk, a transplant nephrologist and a volunteer at the National Kidney Foundation, told ABC News, “One risk factor that is related to race is the racism,” Farouk said.

“So, thinking about decreased access to care and decreased access to medications, decreased access to optimal diabetes, and high blood pressure control. It really goes back to this initial assumption that race is a biological variable [which isn’t accurate].”

Racial bias permeates the entire kidney transplant system, from the calculation for the kidney profile index to the kidney transplant waitlist, but a vote scheduled for June by the Organ Procurement and Transplantation Network hopes to address the kidney profile index’s inequities. In the meantime, of the 14,280 Black candidates who were moved up on the waitlist between January 2023 and March 2024, 3,000 have received transplants.

Michelle Josephson, a former president of the American Society of Nephrology, told ABC News that she hopes the transplant system will be more efficient moving forward by removing racial inequities.

“There’s a lot of issues in medicine and many other parts of our culture that speak to our very challenging history. And I think this is one of them,” Josephson said. “The good news is that we have pulled race out, and we’ve tried to rectify some of the inequities that occurred because of it.”