Racial Gap Narrowing In Kidney Transplant Rates

Study Says Changes In Criteria Improve Access For Minorities

By Daniela Lamas

Knight Ridder

February 7, 2004

MIAMI -- A shift in how kidneys are matched has led to significant strides in giving blacks and Hispanics greater access to lifesaving transplants, a study in the current issue of the New England Journal of Medicine reports.

Blacks and Hispanics face twice the waiting time for kidneys as whites, in part because blacks are three times more likely to have kidney failure though kidney donations among these two groups have not kept pace.

More than half of about 57,000 Americans waiting for kidneys are black or Hispanic, but they receive slightly more than a third of kidney transplants. Organ matches are more likely between people of the same racial or ethnic group.

"We have to increase the organ and tissue donor pool by getting minorities to understand the benefits and not fear donation as a whole," said Ishmael Sharpe, a manager at Life Alliance Organ Recovery Agency, which harvests organs for transplants in southeastern Florida.

A study by researchers at five institutions from California to New York analyzed easing the criteria for matching to give minorities a greater chance at available kidneys.

The change, adopted in May by the United Network for Organ Sharing, has increased the number of minorities who received kidneys by about 7 percent, said Dr. Friedrich Port, president of the University Renal Research and Education Association in Ann Arbor, Mich. The gain comes with a 2 percent higher rate of transplant failure.

"It does not equalize the disadvantage, but it does minimize it," Port said. "What we showed is that there was a very low price for a big benefit in reducing the disadvantage of minorities."

This is just a small step, say doctors and organ donation specialists in southern Florida who are working to encourage donations in minority populations and are experimenting with stronger drug regimens to prevent rejection.

Doctors at the University of Miami School of Medicine last year published their results using new immunosuppressant drugs that yielded a success rate of about 97 percent one year after kidney transplant -- even in minorities, who suffer higher rates of rejection. Nationally, the success rate is 88 percent in blacks and 93 percent in Hispanics.

"I think what we did is put the right combination together," said Dr. Gaetano Ciancio, a UM professor of surgery and urology.

Beyond immunosuppressants and the paucity of organs, doctors trace these problems to high blood pressure and diabetes that are disproportionate in minority populations.

Untreated, these conditions can cause kidney disease, swelling dialysis clinics and organ waiting lists.

"We need much more research funding to identify the other factors that wind up with African-Americans and other minorities having such a predisposition to diabetes and heart failure," said Dr. Clive Callender, founder of the National Minority Organ and Tissue Transplant Education Program.

The way kidneys from deceased donors are allocated depends primarily on the length of time on the waiting list and the recipient's compatibility with the donor. Compatibility is based on blood type and genetic markers.

The study in the journal analyzed whether getting rid of one of the genetic markers -- HLA-B -- would shift kidneys from whites to blacks and Hispanics, with a small cost. The researchers found that if the HLA-B match were discounted, 166 transplants that went to whites in 2000 would have gone to minorities instead.

This shift, while significant, merely reallocates existing donor kidneys. But Port said more work needs to be done to ease the widespread shortage of organs.

Since Callender began his education program in 1991, rates of organ donation among minorites have nearly doubled, he said. Still, Ciancio said he has encountered a host of misconceptions that discourage donations.

"This is like a Pandora's box," said Ciancio, associate director of kidney transplantation at UM. Some people fear that prospective organ donors will be left to die in an emergency department by doctors who want to get their organs for transplant or that the organs will go only to the richest people on the waiting list.

Copyright © 2004 Globe Newspaper Company.

This article posted Marcy 3, 2004.