Goodbye Race Coefficients. Hello Transplant Equity!

By Morgan Reid, National Kidney Foundation's Director of Transplant Policy and Strategy 

Happy Black History Month! The National Kidney Foundation is thrilled to celebrate advancements in transplant equity. As an organization, our advocacy has contributed to significant strides in closing disparity gaps in transplant access. 

What Does Race Have to Do With it

Race is a social construct, and because it’s not biological, we believe it has no place in clinical formulas that assess kidney function. We developed a task force with the American Society of Nephrology and successfully advocated for the elimination of the Black race co-efficient in the eGFR equation (read the final report). Now, Black patients can have their kidney function assessed equitably and be referred for transplant sooner, as the race-based eGFR test falsely rated kidney function to be better than it actually was for Black patients.

Our latest move to progress equity in transplantation was through persistent communication with the Organ Procurement and Transplant Network (OPTN) and the Health Resources and Services Administration (HRSA) to remove the African American donor characteristic from the Kidney Donor Risk Index or KDRI. This clinical algorithm has unfairly calculated kidneys from deceased African American organ donors as being of lesser quality than kidneys from White deceased organ donors. After months of advocacy, OPTN has a policy to refit the KDRI algorithm without ethnicity. We hope this becomes an official OPTN policy and will make more kidneys available for transplant.

Sign your support to remove race from the KDRI.

Equitable Transplant Access

Adopting the race-free GFR equation led the OPTN to create a policy mandating all transplant centers to use race-neutral kidney function tests when evaluating patients for transplant candidacy. Another monumental action followed: the OPTN restored transplant wait times to Black patients affected by the race-inclusive eGFR equation, which NKF steadfastly supported. We are critically aware of how difficult it has been and continues to be for Black patients to access the national kidney transplant waitlist; we are proponents of these restorative justice policies.

HRSA has taken on the enormous, yet necessary, task of modernizing the U.S. transplant system, and we are thrilled to learn that patients will be at the center of this initiative. After all, isn’t that who our transplant system serves? The different stakeholders in the transplant system all collect an abundance of data, yet standardized and transparently reported pre-wait list data has been detrimentally absent. 

Pre-waitlist data refers to transplant referral and transplant evaluation information. HRSA recently announced that collecting this data will be part of the modernization initiative—a HUGE win! Visibility into this data will convey referral patterns—showing us who is being referred for transplant and who is not—and data about the evaluation process to implement interventions that may reduce barriers in the referral and evaluation phases.

Final Thoughts

The good Reverend Martin Luther King Jr. said, “Of all the forms of inequality, injustice in health is the most shocking and inhumane.” We envision a future where everyone can receive a life-saving kidney transplant regardless of race, ethnicity, zip code, gender identity, sexual orientation, and immigration status. And like the late Representative John Lewis, we will get into “good trouble” in our fight to make this a reality. 

Make a difference. Become a Voices for Kidney Health advocate.