New Policy Reduces Racial Disparity in Transplantation
New York, NY (October 26, 2011) — A change in the kidney allocation policy dramatically reduced the racial disparity between the rates at which African Americans and whites receive deceased donor kidney transplants (DDKT), according to a study published in the November issue of the American Journal of Kidney Diseases, the official journal of the National Kidney Foundation.
In 2003, the United Network for Organ Sharing (UNOS) reversed a policy which assigned priority to potential kidney recipients who genetically matched up with the deceased donor in terms of HLA-B, an antigen found on the surface of cells that is involved in the immune response to foreign tissue and tends to be racially clustered. The preference given HLA-B matches, combined with a higher percentage of white donors, resulted in almost inevitable racial disparity in DDKT recipients.
Researchers from the Johns Hopkins School of Medicine led by Dr. Erin Hall studied the consequences of the policy change on the racial inequality for a DDKT by examining the length of time 178,902 patients waited from initially being placed on the kidney transplant waiting list to the actual transplant. They found that before the policy change, African Americans were 37% less likely to receive a DDKT than their white counterparts; and after the change in policy, African Americans were only 23% less likely to receive a DDKT than whites.
According to Dr. Dorry Segev, the study’s senior author, the policy change has not affected the transplant success rate. "With today’s anti-rejection medications, it is likely that HLA matching is less relevant than in the past, but probably not completely irrelevant.”
Although the new policy dramatically reduced the inequality between African Americans and whites receiving a DDKT, a sizable disparity still remains. “While HLA-B matching was a disparity that resulted specifically from the allocation system, it is likely that the residual causes are at the patient and provider levels,” says Segev.
“For example, a patient may be reluctant to accept certain organ offers, or there may be geographic disparities involved. Another possibility is the conventional thinking that African Americans do better on dialysis than Caucasians. If a patient or his physician feels that he will do just fine on dialysis, he will be more reluctant to accept the up-front risk of the transplant. Studies have found that while this is true in older patients, it is actually the opposite in younger ones. Younger African Americans do far worse on dialysis than their Caucasian counterparts.”
According to the National Kidney Foundation, nearly 90,000 Americans are currently awaiting life-saving kidney transplants. “African Americans are disproportionately affected by kidney failure. The incidence per million is 783 in African Americans, compared with 295 in whites ,” said Dr. Kerry Willis, Senior Vice President for Medical and Scientific Activities at the National Kidney Foundation, “Providing equal access to kidney transplants is an important goal the National Kidney Foundation is working towards through its End the Wait initiative.”
The National Kidney Foundation is the major national voluntary health agency dedicated to preventing kidney and urinary tract diseases, improving the health and well being of individuals and families affected by these diseases and increasing availability of all organs for transplantation. For more information on organ donation visit www.kidney.org