Kidney disease overwhelmingly impacts minority communities. “African Americans are three times more likely, and Hispanics are 2.5% more likely to end up on dialysis than non-blacks,” according to Dr. Sylvia E. Rosas, MD, MSCE, and The National Kidney Foundation President. “We know that there’s a lot of social determinants of health that are involved with who gets kidney disease and who progresses into kidney failure.” Race was a factor in how we were evaluated for transplants, too, but not in the way you think. Now, they are looking at removing it if we want to be donors. But equity is finally leveling the playing field.
The National Kidney Foundation (NKF) and American Society of Nephrology (ASN) on the Organ Procurement and Transplantation Network (OPTN) plans to remove the African American/Black race coefficient from the Kidney Donor Profile Index (KDPI) calculation. This comes after removing the race-based formula for transplantation qualifications a few years ago. This is all good news for us. But let’s ensure your doctors, hospitals, and labs know about these changes and aren’t using old calculations. What does it all mean? Read on.
The Race-Based Formula Explained
Kidney function is measured by a Glomerular Filtration Rate (GFR) Test. The Black race variable was developed from a study that says we have higher creatinine levels. Dr. Rosas explains.” In the big scheme, the critical number is 20 when people are referred and can be listed for transplant. But the white person would be 19, the Black person would be 22, but the wait list is long for everybody.” But think of it like a Black tax.
In the United States, the wait for a kidney could be between five and six years, depending on the state where you live.
“The problem with being waitlisted is your comorbidities are still progressing. So many patients are removed from the waitlists because they no longer qualify,” Dr. Rosas explains. “A kidney transplant is a surgery, and if your health deteriorates because you have to wait longer, that becomes a problem.”
Advocating For a Race-Free Formula
However, Dr. Rosas points out that medical schools teach students there are no differences between races. “The NFK, the ASN, and OPTN said this is the formula we should use because we didn’t want people to still use the other one. You don’t want to go to your cardiologist and have X kidney function, then you go to your primary care, he’s using another formula, and you have another kidney function; it’s confusing,” she explains. “The NFK has worked really hard with lab companies to have the new formula reported.” Between 2023-2024, patients who were on the waitlist got an average of 1.7 years of their time back when race was eliminated from the equation.
How Kidneys From Black Donors Were Evaluated
The Organ Procurement and Transplantation Network used a mathematical equation called a KDRI to estimate the quality of a donated kidney. Under the old equation, kidneys from Black donors were graded as having poorer organ function than kidneys from White donors. As a result, kidneys donated by Black people were often thrown away. The proposed change was included in OPTN’S 2024 winter public comment period and approved for adoption by the OPTN board in June 2024.
In addition to removing race, the updated KDPI no longer includes whether or not the donor was Hepatitis C Virus positive.
Thanks to therapeutic advances, post-transplant outcomes for HCV-positive deceased donor kidney transplants are similar to those of HCV-negative donor kidneys.”With the new approach, some kidneys that may have otherwise been considered unsuitable for transplantation due to the inclusion of race in the formula will now receive more favorable scores, including some that will now be classified with scores that make them more appropriate for transplant,” said Cynthia Delgado, MD, who participated in the Organ Procurement and Transplant Network task force that led efforts to reconsider the use of race and HCV in the formula.
There are many reasons why a donated kidney may not be viable. “Sometimes they’re not good. If they cannot find a donor, the donor doesn’t come on time, and they don’t have a surgeon. Many things could happen,” Dr. Rosas explains.” Four sequences of transplants happened in the United States: the best sequences of your lower score, the lower the number, the better your kidney is. Unfortunately, many of these kidneys end up in the above 85% range.”
Right now, 90,000 people are waiting for kidney transplants, and 12 people die each day waiting.
 Know More About Your Kidney Disease and Transplant Options
Dr. Rosas suggests taking the following and that you know your options:
If You Have a Family History of Hypertension, Diabetes, Kidney Disease or Heart Disease
Request these two tests from your physician annually to assess your kidney health: creatinine and albumin. Work on reversing the progression of chronic kidney disease before it becomes kidney failure.
Check With Your Lab
Make sure they no longer use race-based testing when testing your Glomerular Filtration Rate (GFR).
If You Are On Dialysis (What Have They Said to You About Transplant Eligibility)
If you have been given a brochure, it is time to read it.
If Have Been Turned Down For a Transplant Because Your BMI is too High
Look at other transplant centers; each center sets its eligibility requirements.
