ATLANTA — Black patients waiting on a kidney donation may soon get a transplant up to two years sooner thanks to a national policy change that bans the test previously used to determine eligibility.
Dr. Martha Pavlakis, one of the doctors who championed the change, said the outdated test unfairly factored race into the formula to determine transplant eligibility and necessity.
"The idea of using someone's skin color to put them in a box as if it has some genetic or physiologic meaning actually turned out to be potentially harmful," she said.
Pavlakis is the current chair of the OPTN Kidney Transplantation Committee. She explained the committee took a critical eye to the outdated formula, developed in 1994 and based on a small study.
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“The people that participated in the study were about 1,500 white patients and fewer than 200 Black patients," she said.
Pavlakis said of that small sample size, the Black patients had higher levels of creatinine – an indicator of kidney disease. So the test increased the creatinine threshold Black patients had to reach to qualify for a transplant.
“Anybody who's listed as Black looks a little bit healthier and doesn't get on the transplant list until they’re worse," she explained.
It's known as the "race variable," and it's been used ever since.
“Unfortunately that approach has been rooted in our medical education, our protocols, our approach to guidelines for treatment," Pavlakis said.
The average wait time for Black patients on the transplant list in 2014 was 64 months. For white patients, it was 37 months, even though Black people are four times more likely to be diagnosed with kidney failure than white people.
Pavlakis said the policy change now in effect has banned that test, and instructs every kidney transplant program in the United States to credit affected Black patients with time.
“You can't use the race variable, that's a mandate," she said. "As of January 2023, all transplant programs in the United States have one year to look at their lists, inform everyone on the list that we're doing recalculations.”
Pavlakis said this change means Black patients could get a kidney transplant one to two years sooner than before.
Transplant centers are required to notify patients of all races of how the change will impact them.
"My experience is that most people are in favor of a fairer system for everybody," Pavlakis said. "If people have a sense that rich people get kidneys faster or that the system is racist, right, that will destroy faith in the system."
Notifications for those on the kidney transplant list are still going out through the end of the year.
Pavlakis explained while this policy change only impacts those on the kidney transplant list, she hopes to next address other areas of medicine that use similar "race variables" – like lung surgery, bladder treatment and OBGYN procedures.