A new kidney allocation system helps more minorities get the kidney transplants they need, according to a recent study.
In 2014, the United Network for Organ Sharing (UNOS) implemented the new system, which addresses the primary factor for determining a patient's priority on the waitlist: the length of time the patient has waited for a transplant. In the months following implementation, kidney transplant rates for blacks and Hispanics increased, while kidney transplant rates decreased for whites.
Treatment for end-stage renal disease (ESRD), also known as kidney failure, includes dialysis or kidney transplantation. Because it offers longer survival, fewer hospitalizations and better quality of life than dialysis, kidney transplantation is the preferred treatment for most patients with ESRD.
The new allocation changes the starting point for calculating a patient's wait time. Providers used to consider the date the patient entered the waiting list as the waitlist start date. The clock now starts on the patient's first regular dialysis date or the waitlist date — whichever is earlier.
Because minorities frequently spend more time on dialysis prior to waitlisting than do white patients, UNOS expects this change to help minorities receive the kidney transplants they need.
More than 679,000 Americans had ESRD at the end of 2014, according to the most recent statistics presented by the United States Renal Data System (USRDS). Compared with whites, ESRD was about 3.7 times greater in blacks, 1.5 times greater in Asians and 1.4 times greater in Native Americans.
Historically, minorities are less likely to receive the kidney transplants they need to survive than are their white counterparts. Research shows that nearly 70 percent of white patients added to the waitlist in 2001 received a kidney transplant, while only 54 percent of African-Americans and 57 percent of Asians had received a transplant during that time. More than half of the patients on the waitlist are members of ethnic minorities, and nearly twice as many minorities on the waiting list die.
Using 179,071 UNOS waitlisting records from June 2013 to September 2016, researchers calculated the monthly rates of kidney transplantation among waitlisted patients. They found that, before implantation of the new allocation system, white patients had higher transplant rates than African-Americans and Hispanics. In this assessment, 1.07 percent of white patients per month received kidney transplants, while only 0.80 percent of black patients and 0.79 percent of Hispanic patients received transplants per month.
Monthly rates changed significantly after implementation of the new system, with monthly rates dropping to 0.95 for white patients and increasing to 0.96 percent for African-Americans, and 0.91 percent for Hispanics. Implementation narrowed the difference in the average monthly rates of kidney transplantation by 0.29 percentage points for African-Americans compared to whites and 0.24 percentage points for Hispanic Americans compared to white patients.
The research results appear in the June issue of the healthcare journal, Health Affairs. Taylor Melanson, from Emory's Laney Graduate School, and senior author Rachel Patzer, Ph.D., MPH, assistant professor of surgery in Emory University School of Medicine led the study.
"The policy change appears to have at least temporarily eliminated racial and ethnic disparities in access to kidney transplantation for waitlisted black and Hispanic patients," Melanson says in a press release. "This is a very positive achievement, but continued efforts are needed to address the disparities that exist prior to waitlist, including the racial and ethnic differences in completing the medical evaluation process to be placed on the waitlist."
