Differences in Access to Kidney Transplantation between Hispanic and Non-Hispanic Whites by Geographic Location in the United States

Abstract

SummaryBackground and objectives Hispanic patients undergoing chronic dialysis are less likely to receive a kidney transplant compared with non-Hispanic whites. This study sought to elucidate disparities in the path to receipt of a deceased donor transplant between Hispanic and non-Hispanic whites.Design, setting, participants, & measurements Using the US Renal Data System, 417,801 Caucasians who initiated dialysis between January 1, 1995 and December 31, 2007 with follow-up through 2008 were identified. This study investigated time from first dialysis to first kidney transplantation, time from first dialysis to waitlisting, and time from waitlisting to kidney transplantation. Multivariable Cox regression estimated cause-specific hazard ratios (HR CS ) and subdistribution (competing risk) hazard ratios (HR SD ) for Hispanics versus non-Hispanic whites.Results Hispanics experienced lower adjusted rates of deceased donor kidney transplantation than non-Hispanic whites (HR CS , 0.77; 95% confidence interval [95% CI], 0.75 to 0.80) measured from dialysis initiation. No meaningful differences were found in time from dialysis initiation to placement on the transplant waitlist. Once waitlisted, Hispanics had lower adjusted rates of deceased donor kidney transplantation (HR CS , 0.66; 95% CI, 0.64 to 0.68), and the association attenuated once accounting for competing risks (HR SD , 0.79; 95% CI, 0.77 to 0.81). Additionally controlling for blood type and organ procurement organization further reduced the disparity (HR SD , 0.99; 95% CI, 0.96 to 1.02).Conclusions After accounting for geographic location and controlling for competing risks (e.g., Hispanic survival advantage), the disparity in access to deceased donor transplantation was markedly attenuated among Hispanics compared with non-Hispanic whites. To overcome the geographic disparities that Hispanics encounter in the path to transplantation, organ allocation policy revisions are needed to improve donor organ equity.

The promise of organ and tissue preservation to transform medicine

“…These imbalances disproportionately affect patients with fewer resources, who cannot relocate to join more favorable waiting lists 59,71 . Matching limitations often fall hardest on populations with small pools of potential matching donors, particularly among children and ethnic minorities 60,61,72,73 .…”

Socioeconomic Status and Ethnicity of Deceased Donor Kidney Recipients Compared to Their Donors

“…Although disparities in access to transplantation have been repeatedly demonstrated for Blacks (1,29,30), Black recipients receive over twice as many kidneys as are donated by Black donors (18 598 vs. 8044, Table 3). As in the case of SES and MHI, this apparent paradox is also explained by ethnic differences in ESRD incidence and the need for renal transplantation.…”

Illinois Law Opens Door To Kidney Transplants For Undocumented Immigrants

“…[12][13][14][15][16] African American and Hispanic patients remain underrepresented on kidney waiting lists, relative to the composition of the population with chronic kidney disease. [12][13][14][15][16] African Americans are less likely than whites to be referred for the initial evaluation of transplantation; to be placed on the transplant waiting list; and to receive a transplant, even if they express a desire to receive one instead of continuing lifelong dialysis. 13,15,16 In addition, compared to white patients, minority patients are less likely to complete their transplant evaluations and less likely to become candidates for a transplant.…”

“…However, the facts are indisputable: Proportionately fewer African Americans and Hispanics receive transplants than whites. [12][13][14][15][16] Adding to these disparities are the unique obstacles faced by the 6,000 undocumented immigrants estimated to have end-stage renal disease in the United States. 17 Many of these people have neither the financial resources nor access to public or private insurance to pay for transplantation or other health care services.…”