With kidney disease being one of the leading causes of death in the U.S., it poses a serious public health threat, especially within the Black American community. Black Americans are three times more likely than white Americans to suffer from kidney failure.
Despite making up only 12% of the population, Black Americans account for 35% of individuals with kidney failure. This disparity can be attributed to the higher rates of diabetes and high blood pressure in the Black community, both of which are significant contributors to kidney disease.
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Nearly 100,000 people in the U.S. are waiting for kidney transplants, with Black Americans facing a higher need for transplants but also receiving them at a lower rate. Kidneys from Black donors are more likely to be discarded due to a flawed system that unfairly assesses their quality based on race.
This flawed system raises ethical concerns surrounding justice, fairness, and stewardship of a scarce resource – kidneys.
How Did We Get Here?
The U.S. organ transplantation system evaluates donor kidneys using the kidney donor profile index, which includes various factors, including the donor’s race. Research has shown that kidneys from Black donors are more likely to fail after transplantation, leading to higher discard rates.
Most recipients of kidneys from Black donors are Black Americans, which further perpetuates disparities in transplantation rates.
Risk, Race, and Genetics
Scientists confirm that races are social constructs with poor genetic diversity indicators. Variants of the APOL1 gene are more likely to develop kidney disease, primarily affecting people of African descent.
Research on kidney transplants supports the higher failure rates of kidneys from donors with riskier APOL1 variants, explaining the disparity in Black donor kidney outcomes.
How Might This Practice Change?
Health professionals have an ethical duty to manage and distribute limited resources responsibly, aiming to prevent the unnecessary loss of transplantable kidneys. One approach to address this issue is to focus on genetic variants rather than race to assess kidney quality for transplantation.
Transitioning away from race-based assessments could enhance equity in organ transplantation and reduce the racial disparities present in the current system. By prioritizing genetic factors over race, the transplantation process could become more effective and fair.
Ana S. Iltis, Professor of Philosophy; Carlson Professor of University Studies; and Director, Center for Bioethics, Health and Society, Wake Forest University
This article is republished from The Conversation under a Creative Commons license. Read the original article.