Removing race from kidney tests increases Black patient transplants

According to a recent JAMA Internal Medicine study, the Organ Procurement and Transplantation Network (OPTN)'s decision in 2023 to change its policy and require that transplant centers use the same race-neutral calculation on all kidney transplant candidates to determine their estimated glomerular filtration rate (eGFR) — a measure of how well the kidneys are working — has led to more Black patients getting the kidney transplants they need. 

Specifically, the study found that among Black patients, the policy change was associated with approximately five more transplants for every 1,000 transplant listings. The study also showed that over 21,000 people waiting for a kidney transplant had their wait times reduced. This is thanks to OPTN's decision in December 2023 which required hospitals to assess their wait lists and backdate the wait times for Black candidates who had been disadvantaged by use of the previous race-based equation. On average, these patients gained just over a year and a half of wait time. 

Prior to OPTN's move to using a race-neutral calculation, the separate calculation used for Black patients had overestimated their kidney function. This separate calculation made the kidneys of Black patients look healthier than they really were, leading them to wait longer for kidney transplants than non-Black patients.  

For the people who have had their waitlist time reduced and have been able to receive a kidney transplant sooner, the transition to a race-neutral calculation has been life-changing. Craig Merritt understands this firsthand.

In 2023, Craig received a kidney transplant after being told just a few days earlier that he was being credited for four years on the waitlist because the race-inclusive eGFR calculation forced him to wait longer than he should have had to wait. For Craig, dialysis was a very difficult experience for him, so getting a kidney transplant marked a new beginning; one that may not have been possible for several more years if OPTN had not changed its policy. 

We caught up with Craig recently after the study was published and asked for his thoughts after seeing the impact of the policy change.  

"I am grateful for the improvements that have been made within the community for people of color concerning earlier detection, treatment and wait-time adjustments for transplant," Craig said.  

Still, the researchers behind the JAMA study have stressed that while the results are encouraging, more work needs to be done to understand the longer-term impacts of the OPTN policy update and to ensure that changes to waitlist times are made consistently across transplant centers. In addition, issues including medical bias, implicit bias, financial barriers and systemic barriers all play a role in Black Americans facing longer transplant waitlist times than white Americans. AKF remains committed to addressing these disparities and increasing access to kidney transplants. 

To read AKF's full response to the JAMA Internal Medicine study, click here. 

Click here to read AKF CEO LaVarne A. Burton's perspective on the increase in transplants among Black candidates. 

View our Transplant Toolkit for more information about kidney transplants. 

For more information about kidney transplant access in the United States, visit our Kidney Health for All® webpage.