Racial Disparities in Selecting Patients for Renal Transplantation
Creators: name: Elmahi, Nadear, MD
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2012

description: Chronic Kidney Disease (CKD) is the slow progressive loss of kidney function. CKD slowly gets worse over time and the loss of function usually takes months to years to occur. The final stage of CKD is called end-stage renal disease (ESRD). At this stage, the kidneys are no longer able to remove wastes and excess fluids from the body and therefore, the patient will need dialysis or a kidney transplant (Churak, 2005; Feldman, Klag, Chiapella, Whelton, 1992). Research has repeatedly revealed the existence of racial disparities in use of renal transplantation where Caucasian patients have an advantage over other groups. The disparities are evident in patient accessibility to kidney transplantation and in placement of patients on the renal transplantation waiting list. Despite high rates of CKD and ESRD in minority groups, these groups are less likely to access renal transplantation compared to Caucasian patients. The evidence gathered from a comprehensive literature review suggests that Caucasian patients in United States have greater access to renal transplantation, leading to the hypothesis that the disparity in selecting patients for renal transplantation is a consequence of racial discrimination. This racial disparity may be more circumstantial than intentional. However, this has not been fully researched and determined. Reviewing data from the Organ Procurement and Transplantation Network (OPTN) and Scientific Registry of Transplant Recipients (SRTR) Annual Report for 2010, it becomes apparent that racial disparities continue to exist in renal transplantation (OPTN SRTR, 2012). The report shows that most racial groups; including Caucasians, African Americans, and Hispanics have gained in absolute numbers of donations received from deceased and living donors; only Asians have not increased in their number of organ donations received. Despite the increase in the total numbers of donations to all the patients, the rates of transplantation remained highest among Caucasians at 66%, while other ethnic and racial groups received less than 15% of needed transplantations. The reasons for the disparities are not obvious, because an increase in living donations is evident and a policy change in 2003 had expanded organ acceptance (OPTN SRTR, 2012). To minimize or eliminate the racial gap in renal transplantation rates, recommendations for leadership include changes designed to facilitate minority patients being placed on the transplantation waiting list early. It is recommended that standardized protocols be established to explain and offer the option of renal transplantation for appropriate candidates at the time of initiating permanent dialysis. A second recommendation is to improve the waiting list process by developing a regional network that increases the opportunity for those on the waiting list to receive an organ. A third recommendation is to establish guidelines for living donor kidney transplantation, especially for African American patients. This can be achieved by developing education programs for donors and patients to encourage the use of living donor organs. The fourth and final recommendation is to plan future research to explore the reasons behind the persistence of racial disparities in renal transplantation despite policy change and increases in living kidney donations. Possible actors to implement those changes will include physician and nephrologists’ associations, the American Association of Kidney Patients, the National Kidney Foundation and the United Network for Organ Sharing.