The Black And White Of Organ Transplants: Equity In The Gift Of Life

While Black Americans comprise about 28% of candidates waiting for an organ transplant, just 13% of organ donors in 2020 were Black.

As much as COVID-19 has exacerbated long-standing health disparities in America – Blacks have had a 70% greater chance of death due to COVID-19 than whites – this, of course, is not the only shocking inequity in American health care. Tragically, the effort to save lives through organ transplantation is marred by a deep chasm separating the treatment of Blacks from whites.

Black Americans die every day waiting for an organ because the transplantation system in America is weighted heavily against them, as study after study has shown.

• Black persons are significantly less likely than whites to receive lifesaving kidney transplants, even though they are more than 2.5 times more likely than whites to develop end-stage kidney failure.
• Blacks were about one-quarter as likely as whites to receive a live-donor kidney between 2010 and 2014, an increase in disparity from the late 1990s when they were half as likely to receive a live-donor kidney.
• Once placed on the waiting list for a kidney transplant, white patients have had a shorter wait time for a transplant than Blacks. 
• The number of organ transplants performed on Blacks in 2020 was just 28% of the Blacks waiting recently for a transplant. In contrast, the number of transplants performed on whites accounted for nearly 48% of the whites waiting on the list. 

Everyone deserves an equal chance at living a full life. To achieve this most basic measure of fairness, there must be reforms to the organ transplantation process.

This should be a core element of the push for health equity in the United States, which already is growing as a result of COVID-19’s heavy toll on the Black community.

Organ procurement organizations, which manage the clinical and logistical work involved in deceased organ donors giving the gift of life, have a reputation of not working as effectively on behalf of Black patients as whites.

As the new leader of the OPO for the New York metropolitan area – LiveOnNY – and as one of the very few minority CEOs in the industry, I implore all organ procurement organizations across the nation to prioritize health equity as we are in New York, where more than 65% of our transplant recipients last year were non-white patients.

The U.S. Department of Health and Human Services is appropriately tightening its monitoring of OPOs to meet new and improved benchmark standards for organ transplantations. Health equity should specifically and explicitly be added to these efforts.

But responsibility also lies within our communities of color, which donate organs at a lower rate than whites.

Since organ compatibility is often tied to racial background, this places Black patients in need of a transplant at a disadvantage.

Even as Blacks comprise about 28% of candidates waiting for an organ transplant, just 13% of organ donors in 2020 were Black.

Medical schools at the nation’s historically Black colleges and universities are partnering with the Association of Organ Procurement Organizations and the Organ Donation Advocacy Group to increase the number of Black donors and combat disparities.

These partnerships are representative of the critical steps that are necessary to reduce health inequity, and the industry needs to sponsor more efforts like them.

Another sign of progress: Directors of the Organ Procurement and Transplantation Network, which establishes policies for donations and transplants in the U.S., voted effective July 27 to require transplant hospitals to use a race-neutral calculation of kidney function in determining eligibility for a transplant.

According to the OPTN release, some prior calculations used included a modifier for patients identified as Black, which resulted in a systemic underestimation of the severity of Black patients’ kidney disease.

That means some patients who could have been deemed eligible for a transplant at an earlier point may not have been.

Still, the U.S. transplantation system needs further reform to ensure that once a viable organ is donated, it is allocated efficiently and fairly and is put to good use.

Congress tasked the National Academies of Sciences, Engineering, and Medicine with investigating this challenge.

The Academies’ resulting report recommends critical steps toward equity in organ transplantation, which I wholeheartedly endorse.

For example, patients today who have not yet started dialysis can preemptively join the waiting list for a kidney transplant and gain “waiting time credit” that can help them qualify for a kidney more quickly. But the report recommends that an end-stage kidney disease patient should only gain this credit once they’ve actually started dialysis – a move that would benefit Black patients, as they’ve typically logged more time on dialysis than whites by the time they’ve been offered access to the waiting list.

This change would eliminate “the current preferential access to deceased donor kidneys for individuals able to gain timely access to referral for transplant and the transplant waiting list,” the report’s summary states. Dialysis centers also should be legally obligated to inform all patients of their rights and assist them in joining the waiting list for a kidney.

In addition, the U.S. needs better educational outreach to patients who will require an organ transplant, particularly regarding waitlist rules. Sadly, one analysis indicates some health care providers do not educate Black patients about transplantation because they are more likely to be assessed as psychologically unfit. Meanwhile, the analysis found, patients who were uninformed had a 53% lower rate of access to transplantation.

Then there is timing. Because more people of color, proportionally, are on the waitlist for organs, they disproportionately suffer from the transplantation system’s inefficiencies. Some studies point to a “weekend effect,” in which kidneys and livers procured on weekends have been less likely to be transplanted. This may be due to lower staffing levels at hospitals on Fridays, Saturdays and Sundays – a shameful excuse for failing to perform a lifesaving procedure.

The precious lives of those who depend on the health care system are at stake. The U.S. must improve the organ procurement and transplantation system to save more people, and it must do so with the aim of ending long-standing disparities that have shortened the lifespans of too many Black Americans.

Photo credit: Source.