Why African Americans Are Waiting Longer for a Kidney Transplant

While it may be common knowledge that Blacks suffer from a higher rate of kidney disease—including ESRD (i.e., end-stage renal disease)—what many people may not know is that it takes longer for Blacks to get a kidney transplant when they need one, compared to whites. What makes Blacks more likely to need a transplant, and why does it take longer to get one?

What Do the Statistics Say?

Although Black people comprise only 12 percent of the population in the United States, they make up over 30 percent of those treated for a condition called end-stage renal (kidney) disease (ESRD). Having ESRD means that a person’s kidneys are not functioning properly and kidney dialysis or a kidney transplant is needed. It’s important to note that the primary causes of ESRD include diabetes and high blood pressure. Other related statistics, reported by the National Kidney Foundation include:

20% of Blacks do not have health insurance
Blacks are less likely to receive referrals to specialists who conduct a pre-transplant evaluation
Blacks are 4 times more likely than white Americans to have kidney failure
13.2% of Black adults have been diagnosed with diabetes
High blood pressure occurs in 1 out of 3 Blacks (one of the highest rates worldwide)
Many Blacks may be unaware that untreated high blood pressure can lead to kidney disease

African Americans and Kidney Disease

Certain health conditions, such as diabetes and high blood pressure (hypertension) increase the risk of severe kidney disease. According to the U.S. Department of Health and Human Services Office of Minority Health, Black American adults are 70 percent more likely than whites to have been diagnosed with diabetes.

Another factor that impacts racial disparities between Black and white rates of kidney disease is high blood pressure, which occurs in approximately 33 percent of the Black population and 20 percent in whites.

Blacks are also known to have a higher rate of inadequate healthcare assess, and their high blood pressure is more likely left untreated. Other factors, such as diet, urban living, stress and poverty also contribute to an increased rate of kidney disease in Black Americans.

When getting a kidney transplant, Blacks are known to have poor outcomes from longer wait times as well as a higher rate of kidney rejection.

How Long Do Blacks Wait for a Kidney Transplant vs. Whites

Getting on the national transplant waiting list is the first step in receiving a transplant for most people. Almost everyone who doesn’t have a living donor (i.e., a family member) option, and even some who do, must wait for some time to get a kidney transplant. This is due to a shortage of organs to meet the needs of those requiring a kidney transplant.

Studies show that Blacks with end-stage kidney disease (ESRD) are the least likely to get put on the waitlist than any other racial group. Statistically, only 17.8% of Blacks with ESRD are put on the national transplant waiting list during the first year of kidney failure. On the other hand, 30.5% of whites with ESRD are waitlisted in the initial 12 months of kidney failure. Why is this?

Wanted: More African American Kidney Donors

Why Blacks Wait longer

There are many reasons identified by various research studies that represent why Blacks must wait longer for a kidney transplant, these include:

Commonly, kidney transplant recipients receive organ transplants from a relative donor. According to an L.A. Times report, a New York study involved healthcare providers who approached 600 family members of people in need of transplants in the 1980s; 69% of the Whites and only 45% of the Blacks agreed to donate kidneys to their family members.
The U.S. kidney allocation matching system uses genetics to match recipients with donors; 90% of organ donors are Caucasian-Americans. According to the Cleveland Clinic, Caucasian-American recipients are a better match when using this system.
Specific formulas are used by doctors and labs to determine GFR (glomerular filtration rate); these formulas measure the effectiveness of a person's kidneys. Low kidney filtration rates indicate impaired kidney function. The calculation formula factors in a person’s sex and age into the final lab result. However, with a Black patient, the person's race also weighs in. A "race adjustment" factor is applied to the estimated GFR number so that Black patients with long-term kidney disease end up with higher values. Higher filtration rates mean better kidney function, and critics say that correcting for race could interfere with critical referrals to specialists, resulting in poorer outcomes.

Staying on Dialysis vs Getting a Kidney Transplant

Getting a kidney transplant involves weighing the pros and cons. Any type of surgery—including a kidney transplant—comes with risks and drawbacks, such as:

Infection
Organ rejection
The need for a new organ transplant every 9 years
The cost of medications that prevent organ rejection is very high and insurance doesn’t always cover it. Medicare only covers these expenses for one year after surgery.
Medications often cause serious side effects such as a compromised immune system

Studies reveal the benefits of having a kidney transplant instead of staying on dialysis may include:

Living longer
Having a better quality of life (returning to work, freedom to travel, fewer dietary restrictions)

A Word from Black Doctor

Early detection of kidney disease and an understanding of its risk factors are key to preventing chronic kidney disease. Everyone should undergo regular testing, but people at risk—such as those with high blood pressure or diabetes—should undergo testing more often. Regular medical screening should be done to detect and treat hypertension and diabetes before these conditions can do long-term damage, interfering with a person’s normal kidney function.