Correcting a Biased Kidney Test Boosts Black Transplant Access
An unprecedented initiative to address the harm caused by a racially biased medical test, which historically blocked or delayed Black individuals from receiving kidney transplants, is demonstrating significant success. Researchers announced on Monday that thousands of Black transplant candidates have been granted credit on waiting lists for time lost due to this flawed test, enhancing their priority in a move toward restorative justice.
How the Biased Test Worked
The problematic test employed a race-based formula to estimate kidney function, inaccurately portraying Black patients' kidneys as healthier than they actually were. This misrepresentation delayed diagnoses of impending organ failure and referrals for transplants, exacerbating existing healthcare disparities.
Following the discontinuation of the race-based test by the U.S. transplant system, hospitals were mandated to review medical records to identify Black patients who could have qualified for transplants earlier. The goal was to credit them with the lost waiting time, aiming to rectify past injustices.
Research Findings and Impact
A team from Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital, and Boston Medical Center analyzed data from all kidney transplants between January 2022 and June 2025. They compared rates before and after the policy change implemented in January 2023.
Among over 21,000 Black transplant candidates who received waiting time modifications, the median gain was 1.7 years. This adjustment is crucial, as the average wait for a kidney transplant spans three to five years, with longer delays in certain regions. Immediately after the policy change, the transplant rate for Black patients increased by 5.3 transplants per 1,000 listings before stabilizing.
Overall, kidney transplant rates rose during the study period, while rates for non-Black patients remained largely unchanged, with white patients continuing to have the highest rates. Dr. L. Ebony Boulware of Wake Forest University School of Medicine, in an accompanying commentary, noted that these findings indicate improving care for Black individuals did not harm other racial groups. She advocated for similar efforts to mitigate harm from other erroneously race-based medical tests.
Challenges and Future Steps
Dr. Rohan Khazanchi of Brigham and Women’s Hospital and Boston Medical Center, who led the study, emphasized that the policy helps advance equity. However, receiving wait-time credit did not guarantee immediate transplants; during the study, 7,484 of the credited patients received a new kidney.
The biased test was based on creatinine filtration rates, with a 1999 equation adjusted for Black patients based on limited studies and outdated theories. This test worsened disparities, as Black Americans are over three times more likely than white people to experience kidney failure and constitute about 30% of the transplant list.
Khazanchi expressed surprise that less than one-third of Black transplant candidates received wait-time modifications. Potential reasons include late diagnoses leading to emergency dialysis or varying resources among transplant centers to investigate old medical records across different health systems.
While the lookback to adjust wait times occurred in 2023, Khazanchi advised that Black patients recently added to transplant lists should inquire about their eligibility for similar credits.
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