The truth about kidney transplant access in America

Even though Black and Hispanic/Latino Americans are more likely than white Americans to develop kidney failure, also called end-stage renal disease (ESRD) or end-stage kidney disease (ESKD), they are often on the kidney transplant waitlist the longest. 

• Black Americans are about 25% less likely to be placed on the kidney transplant list than white patients.
• Once on the list, Black patients often wait more than three years for a kidney, compared with about two years for white patients.
• Hispanic/Latino patients also face delays, often waiting months to years longer than white patients for a deceased donor kidney.
• Based on a University of California Irvine study, Hispanic patients are less likely to receive a kidney from a living organ donor than white patients.
• Although Black people make up about one-third of those on the waitlist, they receive only about 14% of living donor kidney transplants.

Access to kidney transplant 

Reasons for differences in Kidney Transplant 

Medical bias

Some medical rules and tests have made it harder for people of color to be referred for a transplant.

• eGFR calculations: For many years, kidney function tests (eGFR or estimated glomerular filtration rate) included race, which made Black patients' kidneys look healthier than they were. This delayed referrals to kidney doctors for thousands of people. Since 2021, race is no longer used in eGFR calculations.
• BMI limits: Some programs use strict body-mass index (BMI) cut-offs, even when weight alone may not predict the success of a transplant.
• Other assumptions: Health care professionals may make decisions based on genetics or outdated rules instead of a person's overall health and support system.
• Immunologic compatibility testing bias: Tests used to match organs are often based on genetic information from mostly white donors. This makes it harder for people of color to find a close match and can cause longer wait times for a kidney transplant.

Implicit bias 

Implicit bias are thoughts or feelings about people you don't realize you have. Hidden feelings, beliefs or stereotypes can affect how health care professionals talk about transplant and which patients they refer to a kidney doctor. These biases can lead to fewer referrals and slower progress for people of color. Examples include:

• Assuming some patients won't be able to take medicines on time or keep follow-up visits after surgery
• Believing people from certain communities won't have enough support at home to manage recovery
• Spending less time explaining transplant options or answering questions for patients of color
• Expecting worse results based on race or ethnicity rather than looking at a person's health and support system

Financial barriers

Finances often influence who is referred, evaluated and able to stay on a transplant list. 

• Limited or no health insurance may keep people from seeing a specialist or getting listed
• Out-of-pocket costs, including travel, lodging, or lost wages, can discourage evaluation
• Some people worry they cannot afford the medicines needed after a transplant

Systemic barriers

Access to transplant care depends on more than medical need. Structural issues, such as the location of transplant centers, housing, transportation, and language support, can make it harder for Black, Hispanic/Latino, and other minority patients to get timely evaluations. None of these challenges should stop you from seeking a transplant. With the right support and information, you can take the steps needed to be evaluated and move toward a kidney transplant.