Dismantling structural racism as a root cause of racial disparities in COVID-19 and transplantation

Abstract

As the United States faces unparalleled challenges due to COVID‐19, racial disparities in health and healthcare have once again taken center stage. If effective interventions to address racial disparities in transplantation, including those magnified by COVID‐19, are to be designed and implemented at the national level, it is first critical to understand the complex mechanisms by which structural, institutional, interpersonal, and internalized racism influence the presence of racial disparities in healthcare and transplantation. Specifically, we must deeply re‐evaluate how scientists and clinicians think about race in the transplant context, and we must actively shift our efforts from merely observing disparities to acknowledging and acting on racism as a root cause underlying the vast majority of these disparities. We must do better to ensure equitable access and outcomes for all transplant patients, including within the current COVID‐19 pandemic. We respectfully offer this viewpoint as a call to action to every reader to join us in working together to help dismantle racist influences and advance transplant equity.

Advancing a Paradigm Shift to Approaching Health Systems in the Field of Living-Donor Kidney Transplantation: An Opinion Piece

“…These include challenges, inefficiencies, and disparities at multiple levels of the systems that are involved with delivering LDKT. 1 - 4 …”

Staying on track to achieve racial justice in kidney care

“… Key advances The nephrology community is leading by example to address harms of racialized medical practices in clinical algorithms by removing the long-standing inclusion of a Black race modifier in equations to estimate kidney function in patients 7 . Efforts to ensure equitable access to transplantation and equitable outcomes for all transplant patients will remain unrealized unless we acknowledge and counter systemic, institutional and interpersonal racism 6 , 8 . Associations between racial disparities in the built environment, such as the integrity of community water sources, can be linked with racial disparities between Black and white patients diagnosed with kidney failure 9 .…”

“…Efforts to ensure equitable access to transplantation and equitable outcomes for all transplant patients will remain unrealized unless we acknowledge and counter systemic, institutional and interpersonal racism 6 , 8 .…”

“…Racism must be named and addressed as a root cause of racial disparities in kidney health, including access to transplantation. As described by Purnell et al, racism operates at an individual, interpersonal and structural level to generate a cascade of barriers to kidney transplantation 8 . Racism affects many stages of the pathway to kidney transplantation, including primary care and kidney disease surveillance, referral to nephrology care, the process of transplantation referral, and transplantation evaluation and listing.…”

Racism: the shameful practices that the medical profession is finally addressing

“…Moreover, investigation also has the potential to advance anti-racism by highlighting and studying the factors that lead to differences in health outcomes (e.g., socioeconomic status or education) versus adjusting for those factors. By placing the spotlight on the connections between social determinants of health or racism and health outcomes, clinical and translational investigators can transform how we understand health and disease considerably [25,26]. To that end, as the harmful effect of discrimination on health, as measured by allostatic load [27][28][29][30][31][32][33], is increasingly recognized, all investigators should consider using metrics like the Everyday Discrimination Scale, as it provides a mechanism by which to examine racism [34][35][36].…”