As American medical organizations continue to embrace racial activism in the name of “health equity,” some experts are warning that more than 10 million non-Black patients with chronic kidney disease are at risk of being bumped from national transplant lists under the latest guidelines. The United Network for Organ Sharing (UNOS), a quasi-governmental nonprofit group that oversees organ transplants in the United States, has purged the national transplant database of anything suggesting physiological differences between ethnicities, moving roughly one million Black patients to the front of the line.
Prior to the “racial reckoning” of 2020, the UNOS transplant list used a formula calculating serum creatinine concentrations to assess a patient’s estimated glomerular filtration rate (eGFR). This calculation, which determines how fast the kidneys are purging excess creatinine from the body, is the best indicator of whether a patient has chronic kidney disease.
For decades, it has been an accepted and provable medical fact that Black people have a naturally higher concentration of serum creatinine than White people, sometimes up to six times higher than non-Blacks with the same kidney function. Essentially, normal function for a healthy Black person would be the same as end-stage kidney disease for a White person. According to the National Library of Medicine, “these differences have been assumed to be largely related to race-related differences in body composition, especially muscle mass.”
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With these critical differences in mind, UNOS previously utilized an ethnicity-based calculation to ensure that the sickest patients with the most urgent need were given priority, regardless of race. These standards were first implemented in 1999 and last updated in 2009.
However, in the wake of George Floyd’s death and the ensuing protests, activists claimed that these race-based constants reinforced systemic racism, prompting the National Kidney Foundation and the American Society of Nephrology to “reassess inclusion of race in the estimation of glomerular filtration rate.” The taskforce appointed to this assessment released a race-neutral formula in 2021.
In December 2022, UNOS’s board mandated that all transplant centers apply the new formula to reassess the rankings on the national kidney waitlist via the new formula. That process, which was completed in December 2023, moved the average wait time of 6,100 Black patients up by an average of 1.7 years—which necessarily pushed a similar number of non-Black patients further down the list.
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Under the new system—which ironically is now more racially biased than the one that came before—Black patients with less advanced kidney disease are now eligible for treatment and transplants years before White patients at the brink of death.
According to a team of researchers publishing in the Journal of the American Society of Nephrology:
The new formula will deem more than 10 million nonblack patients to have either less severe chronic kidney disease or no disease at all — while deeming more than 1 million black patients to have more severe disease or to have disease for the first time. Because the new formula doesn’t include the necessary racial adjustments, however, these reclassifications misrepresent reality.
Put simply, based only on eGFR data that does not take race into account, a perfectly healthy Black person could apply for a new kidney before a non-Black person with late-stage kidney failure.
Per the expert assessment, for every one Black patient moved up the list, ten non-Black patients are at risk of losing access to a transplant. Since January 2023, approximately 490 less-sick individuals have been given a new kidney under the new system.
Connor Walcott is a staff writer for Valuetainment.com. Follow Connor on X and look for him on VT’s “The Unusual Suspects.”
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