Kidney disease is a leading cause of death in the U.S., with Black Americans three times more likely than white Americans to develop kidney failure. Despite constituting only 12% of the U.S. population, Black Americans account for 35% of those with kidney failure. This disparity is partly due to the higher prevalence of diabetes and high blood pressure, the two largest contributors to kidney disease, in the Black community.
Nearly 100,000 people in the U.S. are awaiting kidney transplantation. Although Black Americans are more likely to need transplants, they are less likely to receive them. Compounding the issue, kidneys from Black donors are more likely to be discarded due to a flawed system that erroneously considers all Black donor kidneys as more likely to stop working after a transplant than kidneys from donors of other races.
The U.S. organ transplantation system rates donor kidneys using an algorithm that includes factors such as the donor’s age, height, weight, and history of hypertension and diabetes. Race is also a factor in this algorithm. Consequently, kidneys donated by Black people are discarded at higher rates because the algorithm downgrades their quality based on the donor’s race. This means that some good kidneys may be wasted, raising several ethical and practical concerns.
Scientists have shown that races are social constructs that are poor indicators of human genetic diversity. It is possible that the explanation for observed differences in outcomes lies in genetics and not in race. People who have two copies of certain forms or variants of the APOL1 gene are more likely to develop kidney disease. Medical researchers do not yet understand what is behind this difference, but genetics is likely only part of the story. Environment and exposure to certain viruses are also possible explanations.
“Kidneys from Black donors are more likely to be thrown away − a bioethicist explains why” (June 25, 2024)
