In the past, nephrologists made a groundbreaking effort to eliminate race from a crucial clinical algorithm in an attempt to rectify the harms caused by the race-based equation. The equation for estimating glomerular filtration rate (eGFR), used to assess kidney function, was found to inflate results for Black patients by up to 21%, potentially concealing severe kidney disease and delaying necessary transplants. This discrepancy led to the removal of the equation in 2022, with the Organ Procurement and Transplantation Network requiring transplant programs to submit adjustments for Black patients awaiting transplants.
A recent study examining the impact of this change revealed significant outcomes, affecting 27% of Black patients and resulting in 5.3 more transplants per 1000 Black candidates. The positive results were praised by LaVarne A. Burton, the president and CEO of the American Kidney Fund, as a step towards ensuring fairness and equity in kidney transplantation across the United States.
The initiative to remove race from the eGFR was a contentious process that divided the nephrology community for years. Despite resistance from some quarters, the decision to adopt a race-neutral equation was groundbreaking and set a precedent for other medical fields. However, the study highlighted that many other tools still incorporate race as a variable in their algorithms.
The research compared transplant data before and after the implementation of the new OPTN policy in 2023, analyzing over 180,000 candidates, including 56,000 Black individuals. Surprisingly, the study found that non-Black patients did not experience reduced chances of receiving a transplant during the study period. This challenges the notion that improving transplant rates for Black individuals would come at the expense of others, as noted in an accompanying editorial by several physicians.
While the OPTN policy achieved its intended goal, it did not completely eliminate racial disparities in kidney transplantation. Further research indicated that the adjustment primarily benefited patients with regular access to care who were already on the transplant waitlist. Variations in wait time modifications based on where Black candidates received care underscored the need for continued efforts to address inequities in kidney disease treatment.
Dr. Rohan Khazanchi, a health services researcher and Boston Medical Center resident physician involved in the study, emphasized the importance of exploring additional opportunities for policies aimed at promoting racial equity in healthcare. He has been advocating for similar interventions in other medical domains, such as race-based lung tests affecting worker compensation payouts. This ongoing commitment to addressing systemic inequities underscores the significance of initiatives like the removal of race from clinical algorithms in promoting fair and just healthcare practices.
