Black Americans with kidney failure have historically endured longer wait times for kidney transplants in the U.S. A recent policy change by the Organ Procurement and Transplantation Network (OPTN) may shorten those wait times. Learn more about the revision that enables greater racial equity and inclusivity in kidney transplantation.*

Why have Black patients had to wait longer? 

To be considered for a kidney transplant, there are numerous eligibility requirements you have to meet, including a low enough kidney function measurement, which is determined by a calculation called estimated glomerular filtration rate (eGFR). 

For decades, Black people had higher calculated kidney function due to the mistaken belief among clinicians and scientists that Black people’s greater muscle mass resulted in higher creatinine levels. This unproven belief overestimated Black people’s kidney function by as much as 16%, causing prolonged waits for care and transplants. 

“If organizations continued to use race in the calculations for eGFR rates,” said Melissa Morgan, MHA, CPHQ, ’s director of health equity and quality at Interwell Health, “Black patients would continue to appear less sick, have poor management of their disease, suffer unnecessary stress, and have worse outcomes.”

What change has occurred?

In 2017, at least one university health system began challenging race-based nephrology care, and more followed soon after. In 2021, the National Kidney Foundation (NKF) and the American Society of Nephrology banded together and started a task force to advocate for the removal of race from the eGFR equation. 

Finally, in 2022, after years of advocacy for health equity, the OPTN Board of Directors voted unanimously to remove race from the equation. 

“This change has the potential to increase access to transplants, reduce waiting times, and increase equity in the transplant process,” said Carmen A. Peralta, MD, MAS, Interwell Health’s chief clinical officer. “By removing the race-based equations from clinical use, we also have the potential to identify persons with advanced disease who could benefit from earlier intervention.”

How is the change being put into practice? 

OPTN-member transplant facilities have one year from January 5, 2023, to apply the policy changes to patient care. UNOS Connect, the OPTN learning management system, provided a list of steps to those facilities, along with links to provider and patient education. 

Some key implementation points include: 

• Evaluating or re-evaluating all eligible dialysis and pre-dialysis Black candidates via a race-neutral eGFR equation 
• Retrospectively adjusting waiting times to re-position patients currently on the transplant waiting list
• Informing all patients currently on the transplant waiting list about when they are verified as eligible for a waiting time adjustment, and when their waiting time has been changed 

While this update is long overdue, and there is much that still needs to be done, it is a win for health and medical equity. “If payers and providers can work together to share accountability for reducing health disparities,” Peralta concludes, “I am very hopeful we can see change.”

*Interwell Health – Reimagining Kidney Care. (2023, February 7). Changes Underway May Shorten Black Americans Wait Time for a Kidney Transplant. https://www.interwellhealth.com/our-company/changes-underway-may-shorten-black-americans-wait-time-for-a-kidney-transplant/