Abundant features stories from Trish Phillips (left) Laura Diaz Moore (center) and Curtisha Grant (right).   Living kidney donors stories that speak to understanding and persevering through the factors that contribute to the racial disparity in kidney donation and transplant are key to spreading awareness in diverse communities.

Current UNOS policy assures equity once a patient is on the transplant waiting list.  However, issues related to racial disparity occur before the patient is even placed on the list.  When a patient has end-stage renal disease, transplantation should be the suggested treatment by nephrologists.  However, data shows that African Americans and Hispanics are not offered kidney transplant as a treatment option as frequently as other ethnicities (UNOS). In 2020, 27.7% of African Americans on the organ waiting list received transplants compared to 47.6% of Caucasians (OMH, U.S. Department of Health and Human Services Office of Minority Health). 

Another example of modern-day racial disparity is the limited access African Americans have to renal transplantation. Even though African Americans are almost four times as likely to suffer from kidney failure than non-Hispanic whites (due to the fact that African Americans have higher rates of diabetes and high blood pressure than Caucasians), African Americans have significantly poorer access to renal transplantation than Caucasians.  This is extremely disheartening as renal transplantation is one of the best treatment options for patients with end-stage kidney disease and has several benefits over dialysis including reduced mortality, increased quality of life, and lower healthcare costs.

A study by Medicare/Medicaid Research Review found that one year following renal failure, Caucasians are almost four times more likely to have received a transplant than African Americans (22.7% and 6.0% respectively). Asian-Americans (15.5%) and Native Americans (12.1%) also have transplantation rates that are more than double the rate of African Americans.  This means African Americans are still waiting longer than other ethnicities to get lifesaving kidney transplants when they are in renal failure.

Within the African American community, lack of awareness related to living organ donation poses a huge challenge.  Less awareness results in less living donors coming forward, and less living donors means less lifesaving transplants.  Current statistics highlight the impact less awareness is having within the African American community.  In 2020, 16.4% of living donors were African American.  This is a much smaller percentage than Caucasian living donors who made up 33.4% of living donors. Data also shows 83.6% of organs transplanted to African American patients came from deceased donors. Yet, when it comes to renal failure, the outcomes are better if the kidney is from a living donor.  There are also more advantages to receiving a kidney from a living donor.  For instance, a kidney from a living donor functions immediately, whereas a kidney from a deceased donor may take some time to function properly.

Much of the challenge in improving the racial disparity in kidney transplant, and health care in general, is for the medical community to make culturally competent connections with patients.  Understanding patients’ cultural contexts helps the medical community educate, connect and help patient remove barriers to greater awareness and better resources.  These are often the barriers that exist prior to being waitlisted for kidney transplant.  With the proper connection, healthcare providers can empower patients to be their own advocates and engage them in the donation/transplant process.

Juan C. Caciedo, MD who founded the Northwestern Medicine Transplant Program in Chicago gave an interview for Abundant.  The Northwestern Medicine Transplant Program is designed for culturally competent care for Hispanic (both English- and  Spanish-speaking) transplant patients and their families.  It is a model program for culturally competent care.