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Waiting for a kidney while black

Newsweek has an excellent article, “Who Gets the Organs,” on institutional racism that affects organ transplants. This is truly sad. It’s bad enough that you can be stopped for “driving while black,” but now you can be deathly ill and “waiting for an organ while black.”

According to figures from the United Network for Organ Sharing (UNOS), which administers the organ-allocation system, ethnic minorities make up 50 percent of the 96,581 people on the waiting list, but white patients receive 63 percent of organs. Even for kidney transplants, for which Medicare funding should provide a level playing field, minorities made up 60 percent of the waiting list, but less than 45 percent of transplants. “This is just the tip of the iceberg,” says Dr. Ashwini Sehgal, assistant professor of biostatistics at Case Western Reserve University. A growing body of research shows that black and Hispanic patients face longer delays in getting referred, spend longer on the waiting list and have worse survival rates even after receiving an organ.

The disparities have prompted soul-searching in the medical community. “This is well recognized, but highly controversial,” says Dr. Devon John, a black transplant surgeon at NYU Medical Center. In theory, allocation of organs is race-neutral. Patients receive points for medical need, tissue type and time on the waiting list; doctors use a computer algorithm to decide who gets organs. But they admit the system doesn’t always work as intended. Computer programs alone can’t eliminate the potential for subconscious bias—or overt racism—among the physicians who use them.

Matching criteria for organs and patients is clearly a complicating factor, but once that and the general disparity in access to appropriate care and known bias is factored in, you’ve got a deadly and unfortunate combination that is a blow to minority patients at every step of the process.

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Pam Spaulding

Pam Spaulding