Study finds racial and social disparities in kidney allocation among young transplant recipients

Among younger kidney transplant recipients, a disproportionate number of African Americans and individuals with less education receive organs that are of lower quality or are considered marginal, according to a study appearing in an upcoming issue of the Clinical Journal of the American Society of Nephrology (CJASN). The findings suggest that there are racial and social disparities in the allocation of transplanted organs that need to be addressed.

Older kidney disease patients who have a high risk of dying while on dialysis may benefit from accepting a so-called extended criteria donor (ECD) kidney—which is more likely to fail than a standard criteria donor kidney—rather than remaining on a transplant wait list. But younger patients and those with short wait times are usually better off holding out for a standard criteria donor kidney. Despite this, some young patients still end up receiving ECD kidneys.

Rajesh Mohandas MD, MPH, Mark Segal MD, PhD (University of Florida), and their colleagues looked to see if demographic factors play a role in whether younger patients accept ECD kidneys. They analyzed all first single-kidney transplants documented in the United States from 2000 to 2009 in patients 18 to 40 years of age and waitlisted less than three years.

Among the major findings:

• Of 13,615 ECD transplants, 591 (4.3%) kidneys went to recipients between 18 and 40 years of age who were waitlisted less than three years.
• African Americans were 1.7 times more likely to receive an ECD kidney than Caucasians.
• Individuals with less education were 2.3 times more likely to receive an ECD kidney than those with a college degree; however, African Americans with higher education levels were not more likely to receive such a lower-quality kidney than Caucasians with college degrees.

"To our knowledge, this is the first report showing that there are racial and social disparities in the quality of allocated transplanted organs. Understanding that such disparities exist is the essential first step to addressing inequalities in health care and to attempt to improve patient outcomes," said Dr. Mohandas. He added that it is important to ensure that kidney transplant candidates are not just informed, but also educated about their choices.