A national transplant policy change designed to giveAfrican-American patients greater access to donor kidneys hassliced in half the racial disparities that have long characterizedthe allocation of lifesaving organs, new Johns Hopkins researchsuggests. Before 2003, the researchers note, an African-American patient whojoined the kidney transplant list on the same day as a whitepatient would have a 37 percent smaller chance than a whitecounterpart of getting a transplant. In recent years, theresearchers say, that percentage has dropped to 19. The Hopkins researchers attribute the drop to a 2003 decision bythe United Network for Organ Sharing (UNOS) to a change in therelative priority given to tissue matching. "This is probably the biggest step that the transplant communityhas taken in recent years to reduce disparities in access to kidneytransplants for African-Americans and the good news is it workedextremely well," says transplant surgeon Dorry L. |
Segev, M.D.,Ph.D., an associate professor of surgery at the Johns HopkinsUniversity School of Medicine and leader of the study publishedonline in the American Journal of Kidney Diseases. "The bad newsis, we still have a ways to go." From the very beginning of widespread kidney transplants in theUnited States there has been a racial disparity in who receivedorgans and who died before one became available. A higher proportion of organ donors are white and a higherproportion of those needing kidneys are African-American. Matchesacross race are traditionally more difficult, as physicians havegiven priority to different types of immunologic compatibility,including whether the organ and the donor share the same HumanLeukocyte Antigens (HLA), proteins on the surface of white bloodcells and other tissues in the body that can create organ rejectionand other complications. African-Americans and whites typicallyaren't HLA matches, particularly one subtype known as HLA-B.
"HLA matching was prioritized under the premise that it wouldimprove outcomes," Segev says. "But with advancements inimmunosuppressants, HLA matching isn't as important as it once was.If you match by HLA, you might get only slightly better outcomesnow. A miminal sacrifice in outcomes has meant a big gain inequity." Although the new research from Segev and his colleagues found thatthe UNOS policy change had a profound effect on racial disparitiesin kidney transplant, the transplant gap remains. Previous researchhas shown that African-Americans have been at a disadvantage atevery step of the kidney transplant process including the incidenceand prevalence of kidney failure, referral for transplantevaluation, placement on the waiting list and obtaining atransplant once on the list. Segev says research is needed into why there is still a disparityand how to ensure even more equitable access to lifesaving organs.
The study was funded in part by Health Resources and ServicesAdministration. Source: Johns Hopkins Medicine Additional References Citations.
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