Segregation and live donor kidney transplants
May 2, 2024
Cumulative likelihood of live kidney donor transplant
Source: Li, et al JAMA Int Med February 19, 2024 LINK
Kidney dialysis is lifesaving for people with end stage renal disease, but a kidney transplant is almost always better than getting dialysis. Dialysis is exhausting, and the toxins that build up between dialysis sessions can decrease quality of life. Most dialysis in the U.S. is administered at centers, while in most other developed countries many get their dialysis at home every night. Daily dialysis leads to better outcomes, but kidney transplantation is better still. After a successful kidney transplant, people can return to near-normal lives, although they must continue to take drugs to prevent transplant rejection.
Unfortunately, there are not enough kidneys available for all those who need transplants. There are almost 90,000 on the waiting list, and the U.S. does only 25,000 kidney transplants annually. Here’s a post from last fall about discrimination in putting young Black people on the kidney transplant waiting list.
JAMA Internal Medicine reported last week that research in a large database (160,000 kidney transplant candidates) demonstrated where people live determines whether they get a live donor transplant. Black people with end stage renal disease were far less likely than White people to get a live donor transplant. Black and White people who resided or got their dialysis in a highly segregated neighborhood were statistically significantly less likely to receive a live organ transplant.
Implications for employers:
This is more evidence of structural racism in our health care system, and why it’s important for employers to ask carriers to provide reporting on racial and other disparities to allow for action plans.
This is also a reminder that artificial intelligence systems which are trained on data from existing utilization could use machine learning to create algorithms that could sustain or worsen existing disparities.
Employers can ask their carriers what they are doing to address disparities in the treatment of those with renal failure.
Employers can offer benefits to include home peritoneal or hemodialysis which costs less than dialysis at a center and has better clinical outcomes.
There are some new vendors, including RenaLogic, Rejuvenate, and Cricket Health which offer services to help members with renal failure navigate the medical system and increase their chances to get a kidney transplant.