Making the list -- disparities in kidney transplant waiting lists

Blacks in poor neighborhoods suffer greatest inequality

You might expect that living close to a clinic that specializes in transplanting organs would put you at an advantage if you needed a new kidney. According to an upcoming study in the Journal of the American Society Nephrology (JASN), you would be wrong. The study found that distance from a patient's home to the nearest transplant facility has no bearing on whether an individual is placed on the transplant waiting list. However, the research identified other factors associated with disparities in waitlisting, including neighborhood poverty.

Access to kidney transplants is not equal for all patients, particularly when comparing patients of different races.

Caption: This is Rachel Patzer, MPH, from Emory University. Credit: N/A. Usage Restrictions: None.

To understand this disparity, Rachel Patzer, MPH, Sandra Amaral, MD, and their colleagues at Emory University in Atlanta analyzed data from 1998 to 2002 of 35,346 patients in Georgia, North Carolina, and South Carolina who had end-stage renal disease (ESRD). They found that black patients were less likely than whites to be placed on the kidney transplant waiting list, and this disparity was not associated with the distance to the nearest transplant center. They also found that as neighborhood poverty increased, the likelihood of being placed on the waiting list decreased for blacks compared with whites. "We found the most striking disparity in the poorest neighborhoods, where blacks were 57% less likely to be waitlisted for transplantation than whites," said Patzer.

The researchers offer several potential explanations for these racial disparities. Social, behavioral, cultural, and biologic factors may play a role, as could patient preferences (black patients have been shown to be less likely to want a transplant).

"Exploring the role of these factors in the observed racial differences in waitlisting outcomes is important in developing effective solutions for improving equality in access to healthcare," said senior author William McClellan, MD. Dr. Amaral adds, "Our study suggests that poverty also needs to be considered as an influential factor in these racial differences. Constructing future interventions that reach out to poorer communities may be one approach to mitigate racial disparity in transplantation." ###

Caption: This is William McClellan, M.D., from Emory University. Credit: N/A. Usage Restrictions: None.

The authors report no financial disclosures.

The article, entitled "Neighborhood Poverty and Racial Disparities in Kidney Transplant Waitlisting," will appear online at jasn.asnjournals.org/ on Wednesday, April 1, 2009, doi 10.1681/ASN.2008030335.

Founded in 1966, the American Society of Nephrology (ASN) is the world's largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its world-renowned meetings and first-class publications, disseminates information and educational tools that empower physicians.

Contact: Shari Leventhal, sleventhal@asn-online.org 202-416-0658. American Society of Nephrology