The Historical Bias in Kidney Function Assessment and Its Impact on Black Patients
For decades, a race-based method for evaluating kidney function has unfairly placed Black patients at a disadvantage in the organ transplant system. This practice, rooted in a flawed formula that adjusts lab results based on race, has been widely criticized for perpetuating racial bias in healthcare. The formula, which was used to estimate glomerular filtration rate (GFR), a key indicator of kidney health, falsely suggested that Black patients had better kidney function compared to other racial groups. This biased calculation led to delayed transplant evaluations and longer wait times for Black patients, pushing them to the bottom of the transplant list. Dr. Edmund Pribitkin, a professor at Thomas Jefferson University, highlighted this systemic issue, stating, "We have a long history in this country of biases against certain transplant candidates, in particular African Americans, because of the way that we calculate how bad the kidney function is."
Jazmin Evans’ Journey: A Personal Struggle with Kidney Failure and Racial Bias
Jazmin Evans, a Philadelphia woman, experienced this injustice firsthand after being diagnosed with kidney failure in 2019. Her doctor informed her that her GFR was dangerously low, necessitating dialysis and evaluation for a kidney transplant. As she navigated the complex process, Evans learned about the flawed formula that included race as a variable. Outraged, she commented, "I was outraged because I instantly thought, ‘how the hell could something like this happen for so long?’" Evans’ frustration stemmed not only from the delayed care but also from the broader legacy of racial bias in the medical system. Her story reflects the lived experience of many Black Americans who are disproportionately affected by kidney disease but facing barriers to equitable treatment.
The Flawed Formula and Its Far-Reaching Consequences
The race-based formula used in calculating kidney function has had devastating consequences for Black patients. According to the National Kidney Foundation, Black Americans are over three times more likely than white people to experience kidney failure. Despite this, the formula misleadingly suggested that Black patients had better kidney function, delaying their placement on transplant lists. Approximately 90,000 individuals are currently on the waiting list for a kidney transplant, with about 30% being Black. Evans reflected on the human cost of this bias, stating, "I’ve known people even growing up that has dealt with kidney disease, that has passed away while either on dialysis or waiting for an organ transplant." She wondered how many lives could have been saved if the biased formula had not been used.
Fighting for Change: The Removal of the Race-Based Metric
In response to mounting criticism, the Organ Procurement and Transplantation Network (OPTN) voted in June 2022 to remove the race-based metric from kidney function assessments. This decision was a significant step toward addressing systemic bias in the transplant system. Hospitals were directed to reevaluate the placement of Black patients on waiting lists based on the corrected GFR scores. From January 2023 to mid-March 2023, more than 14,300 Black kidney transplant candidates had their wait times adjusted by an average of two years, according to the United Network for Organ Sharing. This adjustment was a lifeline for many patients who had been unfairly disadvantaged by the flawed formula.
Jazmin Evans’ New Lease on Life: A Transplant and a Fresh Start
Jazmin Evans’ life changed dramatically in April 2023 when she received a letter from the United Network of Organ Sharing. Her wait time was adjusted, and she learned that she should have been on the transplant list since 2015—four years earlier than her initial placement. Just months later, on July 3, Evans received the call she had been waiting for. Her phone, saved under the contact "your kidney is calling you," flashed with the news that a donor kidney was available. Evans rushed to the hospital, where she successfully received a kidney from a deceased donor. Reflecting on her journey, she said, "You know me and my new little kidney, we are getting along just fine." Her story is a testament to resilience and the power of advocacy in overcoming systemic injustice.
A New Era of Equity in Healthcare: Lessons Learned and the Path Forward
The removal of the race-based metric marks a turning point in the fight for equity in healthcare. While the change is a step in the right direction, it also highlights the need for ongoing vigilance to address racial disparities in medicine. Evans’ experience serves as a reminder of the human impact of biased policies and the importance of advocating for systemic change. As she noted, "How many lives would have been impacted? How many people would still be here today?" These questions underscore the urgent need for continued reform to ensure that all patients, regardless of race, have equal access to life-saving care. The story of Jazmin Evans and the thousands of Black patients affected by the flawed formula is a powerful reminder of the importance of equity in healthcare and the transformative impact of justice and advocacy.
