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Racial Equity in Kidney Transplants

This chapter examines disparities between the health outcomes of white people and minorities in organ transplant allocation. Prior to 2015, kidney transplants went to white patients at a much higher rate. A new allocation system was devised in order to change that. The simple, yet ingenious solution attacked the structural cause of the inequity. It kept time on the donation list as the main selection criteria, but the fix by the United Network for Organ Sharing (UNOS) acknowledged that because of underlying health care disparities, black and Hispanic persons spend more time on dialysis before being put on the list. The new system places the starting point at the earliest date a patient was either put on the list for kidney transplants or started regular dialysis treatments. Work in Health Affairs shows that the new UNOS system worked as intended, and that the racial disparities in transplantation have been largely addressed. Transplants are the go-to treatment option for those with end-stage renal disease, increasing the likelihood of survival and better quality of life, while costing one third as much as long-term dialysis.