Flawed Kidney Function Test Discriminated Against Black Patients

Black patients are dismayed to learn they could have received kidney transplants much earlier.

A racially biased medical test used to determine the degree of patient’s kidney failure and rank them on kidney transplant lists is finally being changed. Although Black Americans are three times more likely to have kidney failure than white Americans, they are 25% less likely to be waitlisted for kidney transplant than white peers. An outdated model for assessing kidney function has contributed to inequitable access to transplant options.

The model in question is called the eGFR, or estimated glomerular filtration rate, which measures how quickly a waste substance called creatinine gets filtered from the blood, and from this calculates kidney health. Starting in 1999, the eGFR calculation was widely changed to adjust Black patient’s results based on small-scale research that showed increased creatinine levels in Black people compared to other races. Research has since shown that these race-based calculations may overestimate Black kidney function by as much as 16%, thus causing Black patients to be on transplant waiting lists for longer periods of time. 

In 2022, the United Network for Organ Sharing dictated that transplant centers must use race-neutral criteria to determine placement on transplant lists. They also gave centers one year in which to adjust the waiting times for Black patients already on transplant lists to place them where they would have been on the list without racially biased criteria. Within 6 months of implementing this, 6,103 Black patients were given waiting time modifications, with a median of 1.7 years credited to them. Given that on average, the waiting list for kidney transplant lasts between 3-5 years, this represents a significant number of people who could have received their transplant much sooner. Sadly, for many Black patients who died before they could receive their transplant, this news comes too late. 

Thousands of Black patients have been moved up on the waiting list for kidney transplants after accounting for racial bias.

News like this highlights some of the systemic biases in medical care that can have grave impacts on different communities. Speaking with USA Today, Dr. Pavlakis, medical director of kidney and pancreas transplantation at Beth Israel Deaconess Medical Center in Boston shared, “The fact that as a medical community we, back in the ‘90s when this (modified race-based eGFR) came out, embraced it without questioning it is part of a pattern of these poorly substantiated, race-based assumptions that ended up having profound implications in perpetuating race disparities in medicine.” Other attempts are being made to rectify similar biases as scientifically unfounded, such as the American Heart Association removing race from its calculator of risk for heart disease or cardiac failure.