Who Gets a New Kidney? Study Finds Racial Differences

Study of the role of social factors in differences in access to care

Field of Work: Disparities

Problem Synopsis: In the early 1990s, African Americans were 60 percent less likely to receive kidney transplants than whites, according to a team of investigators at Harvard Medical School. However, there was little information to explain the differences in access to kidney transplants.

Synopsis of the Work: Harvard investigators studied racial differences in clinically appropriate referrals for kidney transplants and the role of patient and physician attitudes in the use of kidney transplants. The team developed criteria for the appropriateness of kidney transplants, examined medical records of and surveyed patients with end-stage renal disease, and surveyed physicians who cared for these patients.

Key Findings: As reported in "Racial Disparities in Access to Renal Transplantation: Clinically Appropriate or Due to Underuse or Overuse?" (New England Journal of Medicine, 2000):

  • African-American patients were less likely than white patients to be considered appropriate candidates for transplantation.
  • Among appropriate candidates, fewer African-Americans than whites were referred for evaluation, were placed on waiting lists or received a transplant.
  • Among inappropriate candidates, more whites than African-Americans were referred for evaluation, were placed on waiting lists or received a transplant.

As reported in "The Effect of Patients' Preferences on Racial Differences in Access to Renal Transplantation" (New England Journal of Medicine, 1999):

  • African-American patients were less likely than white patients to want a transplant or be very certain of their preference; however, these differences were small.
  • African-American patients were much less likely than white patients to have been referred for evaluation and placed on a waiting list for transplantation.

As reported in "Physicians' Beliefs about Racial Differences in Referral for Renal Transplantation" (American Journal of Kidney Diseases, 2004):

  • Nephrologists were less likely to believe that kidney transplantation improves survival for African-American patients than for white patients.