The Organ Procurement and Transplantation Network (OPTN) and the United Network for Organ Sharing (UNOS) are implementing new policies to make skin color a crucial factor in who receives life-saving kidney transplants. The shift is perhaps the most dangerous victory for wokeness in health care to date.
In the name of “equity,” UNOS and OPTN purport to be expanding black patients’ access to kidney transplants. They essentially claim that the longstanding system for such transplants is racist, pointing to how black patients make up 30 percent of the dialysis population and transplant wait list but receive a smaller fraction of kidney transplants.
Activists assert that this disparity reflects bias on the part of treating physicians, particularly when referring black patients for early kidney care. But a study from the Veteran’s Administration found that more referrals for expert care did not improve outcomes or prevent progression of advanced kidney disease to the need for kidney replacement therapy.
If racism doesn’t explain the discrepancy, what does? The list of reasons is extensive, reflecting disheartening, stubborn problems that physicians and policymakers have long tried to address. One is the advanced age and complex medical conditions of many black patients with diabetes-related kidney failure; many of these patients are also relatively satisfied with dialysis treatments and unwilling to undergo extensive evaluation for transplant suitability. Others include insufficient health literacy, concern about the surgical procedures associated with transplantation, and lack of a support system for post-operative patients—an especially important factor in transplant suitability. Black families are also less likely to supply kidney donors from relatives.
UNOS and OPTN ignore these facts to advance a race-based agenda. They are forcing transplant centers to rework the waitlist for cadaveric kidneys in such a way that favors black patients. The rationale is that the longstanding formula used to estimate kidney function, which was race-conscious and required a second calculation for black patients, was racist.
Yet this second calculation was necessary to produce an accurate value for kidney function in black patients. Without it, the measure would be highly inaccurate, dramatically underestimating kidney function. (Research shows that people of African-American descent tend to have higher levels of muscle mass compared with other population groups, which can affect the levels of creatinine, a waste product produced by muscles, in their blood. Creatinine is used as a marker to estimate kidney function in GFR equations, including the MDRD equation; however, African Americans may have higher creatinine levels even if their kidney function is normal.)
Validated in multiple studies involving hundreds of patients, the old approach was long criticized yet never shown to be inaccurate. Nonetheless, activists demanded a new formula, officially rolled out in 2021. Less accurate than the previous method, the new one lowers kidney-function assessment for black patients to the point that some who did not qualify for placement on the transplant list now meet the requirement. It is a case study in politicized manipulation of data to achieve a predetermined goal.
OPTN isn’t just using this new assessment going forward. It is retroactively applying the new formula—potentially tracing back decades—to previous assessments of kidney function in black patients. Many black patients previously regarded as ineligible for the transplantation waitlist will now be listed, and some will even be moved ahead of others already on the waiting list. How many patients waiting for years for a transplant will be forced to wait still longer? Some estimates say that roughly 70,000 black patients could potentially benefit. That’s a huge number, considering that the current kidney waiting list stands at about 90,000 patients.
OPTN is also preparing, in the name of equity, to abandon its longstanding pledge to those who selflessly donated a kidney to a loved one or even to a stranger through a matching program. Currently, these courageous donors are listed at the top of the transplant waiting list should they ever require a transplant. Donating a kidney does not increase the risk of developing kidney failure, so the need is unlikely. Yet this was the only compensation for the charitable act allowed by law. And it helped reassure donors, many understandably worried about the possibility of needing a transplant of their own.
Five times as many whites as blacks donate kidneys, which means that many more whites enjoy this benefit. Activists therefore see it as racist, and they want OPTN to change its policies. The group is considering four proposals; all would eliminate prior donors’ waitlist priority and give them a mere 10 percent–15 percent improvement on their waitlist position. That would virtually eliminate the chance that a white patient might move ahead of a black patient on the wait list, even after he or she donates a kidney. And this policy, which OPTN expects to finalize before the end of this year, risks discouraging kidney donors as a whole. White people are being punished in the name of righting nonexistent wrongs, but patients of every race will suffer from this move.
The corruption of medicine continues apace. Black patients are being pushed toward the front of the kidney-transplant waiting list on the basis of something other than need. Racial reparations have arrived in health care, and kidney transplants are just the beginning.
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