Kidney Transplant Disparities

Kidney Transplant DisparitiesA new transplant allocation system designed to reduce kidney transplant disparities for ethnic patients on the waitlist. According to a research study just published in the June 2017 issue of Health Affairs, a kidney transplant allocation system that was implemented in 2014 by the United Network for Organ Sharing (UNOS) led to reduced imbalance in national kidney transplant disparities among whites, blacks, and Hispanics who were on the transplant waitlist. This new system resulted in a substantial increase in the kidney transplant rate for blacks and Hispanics in the months following implementation.

The research was conducted by an Emory team of investigators, with lead author Taylor Melanson, from Emory’s Laney Graduate School, and senior author Rachel Patzer, Ph.D., MPH, assistant professor of surgery at the Emory University School of Medicine and researcher at the Emory Transplant Center.

Kidney Transplant Allocation System

The new UNOS allocation system aimed to address the primary factor for determining a patient’s priority level on the kidney transplant deceased donor wait list; in other words, how long they have been waiting for a transplant. Minorities, on average, are less likely to complete the necessary medical evaluation to be placed on the national wait list for a transplant. Prior research has shown that this may be due to a variety of factors including poverty, limited dialysis facility staff to educate patients about transplant and physician bias.

Under the new allocation system, the starting point for calculating wait time was changed from the date of waitlisting to either the first regular dialysis date or the waitlist date, whichever was earlier. The change was expected to benefit minorities because they tend to spend more time on dialysis prior to being added to the waitlist than white patients.

Kidney Transplant Disparities Research Results

To determine the effect of the new kidney allocation system on inequality, the researchers examined 179,071 waitlisting records from UNOS from June 2013 to September 2016 and calculated monthly kidney transplant disparities among waitlisted patients.

Prior to the new allocation system, white patients were more likely to receive a kidney transplant (1.07 percent per month) than black (0.80 percent per month) or Hispanic (0.79 percent per month) patients. After implementation of the new system, the monthly rates changed significantly to 0.95 percent for whites, 0.96 percent for blacks, and 0.91 percent for Hispanics. Thus, average monthly kidney transplant disparities narrowed by 0.29 percentage points (rounded) for blacks compared to whites and 0.24 percentage points for Hispanics compared to whites, with both disparities becoming insignificant.

“The policy change appears to have at least temporarily eliminated racial and ethnic disparities in access to kidney transplantation for waitlisted black and Hispanic patients,” says Melanson. “This is a very positive achievement, but continued efforts are needed to address the disparities that exist prior to the waitlist, including the racial and ethnic differences in completing the medical evaluation process to be placed on the waitlist.”

Nearly 700,000 people in the United States have end-stage renal disease, with care for these patients costing Medicare $32.8 billion in 2014. Kidney transplantation is the preferred treatment for most patients with an end-stage disease because it offers longer survival, better quality of life and fewer hospitalizations than dialysis. Transplantation also costs about 65 percent less than dialysis annually.

“It will be important to do additional follow-up and monitoring on the effects of the UNOS policy to fully understand the longer-term consequences and maintain and improve on the disparity reductions,” notes Patzer. “If the disparity reduction is sustained, the kidney allocation system will serve as a valuable example of how health policy can be shaped to immediately reduce racial and ethnic disparities in our health care system.”

Learn more about kidney transplant at the Emory Transplant Center.

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