Disparities in kidney transplants

October 19, 2023

Source: Husein, et al JAMA Int Med, October 2, 2023 LINK

Kidneys remove various toxins from the blood, and those with kidney failure need either a kidney transplant or dialysis. There’s no question about which of these is better - those who have a successful kidney transplant will have a longer lifespan, on average, than an individual who is on dialysis. Kidney transplants are substantially less expensive than ongoing kidney dialysis in the long term.

Unfortunately, there are not enough kidneys available for all of those who need transplants. There are almost 90,000 on the waiting list, and the US does only 25,000 kidney transplants annually. But no one can get a transplant if they aren’t put on the kidney transplant waiting list! Those under 40 are most likely to be good candidates for dialysis, but Black people were 10% less likely to be put on waiting lists compared to White people, and 21% less likely to be put on waiting lists compared to Asian people. The researchers reviewed data on those under 40 who were started on dialysis from 2005 to 2019.

This data was from a period where physicians used an adjustment to kidney function calculators that made it falsely appear that Black people had less kidney impairment, but this does not explain the failure to place Black people on kidney transplant lists after they started dialysis.

Although those with end stage renal failure qualify for Medicare 33 months after they start dialysis, the employer plan continues to pay dialysis claims until the member is on Medicare. Kidney dialysis claims are especially expensive for commercial health insurance plans, which frequently pay more than $100,000 a year even for in-plan dialysis.

Implications for employers:

• Employers should check with medical carriers to be sure that those who are young and on dialysis are placed on kidney transplant waiting lists if they are eligible.

• There are vendors who can help facilitate appropriate referrals to transplant.

• This issue can be considered as part of a broader DEI approach for employers.

• Employers can also check to be sure that dialysis is being administered in-plan, except in rare emergencies or if a member is traveling away from home.

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