According to UNOS , over 100,000 people need a lifesaving organ transplant (total waiting list candidates). Of those, approximately 60,000 people are active waiting list candidates. The most common type of organ to be transplanted is the kidney.
One of the fundamental goals and values of the transplant community is the equitable allocation of organs. The need to eliminate racial disparities in transplantation has long been recognized. African-Americans are disproportionately affected by an insufficient number of organ donors.
For example, although African-Americans comprise just 13% of the U.S. population, they represent 32% of all U.S. patients receiving dialysis due to kidney failure. This is primarily due to the prevalence of hypertension and diabetes – both of which are leading causes of kidney disease – in the African-American community. Problems like these are compounded by the fact that the number of African-Americans who are in need of transplantation is significantly disproportionate to the number who are registered organ donors.
Below is an illustration of these complex mechanisms and how they influence persistent disparities in kidney transplantation. There are several mechanisms by which structural, institutional, and interpersonal racism may influence transplant disparities, and the figure below highlights a few of the examples that have been well-documented in the kidney transplant disparities literature.
(above picture from Purnell TS, Simpson DC, Callender CO, Boulware LE. Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation. Am J Transplant. 2021 Jul;21(7):2327-2332. doi: 10.1111/ajt.16543. Epub 2021 Apr 8. PMID: 33599027; PMCID: PMC8014768.)
Significant steps have been taken to remedy the situation via community outreach projects and educational initiatives. Training of bias reduction, health literacy, language, translation, cultural sensitivity have been introduced into some health systems. New changes to kidney and pancreas allocation policies may help as well as standardized metrics to improve system processes and access.
To learn more about transplant access and bias and racism in surgery and medicine, check out these two podcasts:
- The Northwestern Medicine African American Transplant Access Program with Dinee Simpson, MD: Research: Feinberg School of Medicine: Northwestern University
- Behind The Knife: The Surgery Podcast: Systemic Bias and Structural Racism in Surgery and Medicine on Apple Podcasts
More articles about racial and ethnic disparities in transplantation:
- Evaluation of Racial and Ethnic Disparities in Cardiac Transplantation | Journal of the American Heart Association (ahajournals.org)
- Social Determinants of Health and Race Disparities in Kidney Transplant | American Society of Nephrology (asnjournals.org)
- Dismantling structural racism as a root cause of racial disparities in COVID‐19 and transplantation (jhu.edu)
- Racial/ethnic disparities in waitlisting for deceased donor kidney transplantation 1 year after implementation of the new national kidney allocation system - PubMed (nih.gov)
- African-Americans Face Significant Delays in Liver Transplantation Despite High Priority Scores | AASLD
- Disparities in Liver Transplantation Before and After Introduction of the MELD Score | Gastrointestinal Surgery | JAMA | JAMA Network
There is low representation of women and racial minorities in the transplant surgery workforce and the surgery workforce in general. Below are some articles that discuss workplace mistreatment and how that may lead to hostile work environments for women and racial minorities.