Reconsidering Donor Race in Predicting Allograft and Patient Survival Among Kidney Transplant Recipients

Abstract

Key Points Donor race should not be used in models to predict allograft and patient survival. Removing donor race from the Kidney Donor Risk Index may reduce kidney discard by reclassifying approximately 50% of high kidney donor profile index kidneys. Future prediction models should focus on using relevant biologic factors rather than social constructs when trying to predict outcomes.

The psychosocial needs of adolescent and young adult kidney transplant recipients, and associated interventions: a scoping review

“…A small body of literature elucidates the unique psychosocial needs of minority patients, of low SES and predominantly of Black, Asian and Minority Ethnic (BAME) race and culture. 'Findings from these studies demonstrated that recipients in poverty experience significant adversity' [47][48][49][50][51][52][53][54][55]. A prominent cause is lack of socialised healthcare systems.…”

“…Insurance can also affect the patient's likelihood of getting a transplant when policy does not cover the cost of their donor parent or guardian's care [49]. Poverty is a universal issue that decreases the paediatric recipient's likelihood of recovery [41,47,[50][51][52][53][54][55]. Reasons for this have been elucidated by studies examining the relationship between low SES demographics and transplant outcome [47,[49][50][51][52][53].…”

“…The following social factors were significantly associated with adverse outcomes: having a low-income zip code predicted graft loss [47]; being a black African American young man made one the highest risk group for posttransplant cannabis addiction, and graft loss [50]; Single parent households predicted worse emotional adjustment [51]; mothers' education status predicted IQ scores posttransplant [52]; fatherless households predicted worse medication adherence [53]; poor communication due to language barriers between a patient, their family and medical team was associated with worse adherence to medications [47]; undocumented children often had longer waiting times for specialist treatment due to the added legal and financial complexity involved in their care [49]. Racism is another problem experienced by BAME patients disproportionately [54][55][56]. Studies [54][55][56] highlighted the following: BAME patients' outcomes on a global scale across America, Australia, and in 36 European Countries have been negatively impacted by racism; racial bias has contributed to BAME patients being less likely to be chosen for pre-emptive transplantation and to be considered eligible for waitlisting; studying the impact of racism on outcomes alone is a hugely complex task as confounding variables such as medical factors and psychosocial determinants for health are difficult to accurately control for.…”

“…Racism is another problem experienced by BAME patients disproportionately [54][55][56]. Studies [54][55][56] highlighted the following: BAME patients' outcomes on a global scale across America, Australia, and in 36 European Countries have been negatively impacted by racism; racial bias has contributed to BAME patients being less likely to be chosen for pre-emptive transplantation and to be considered eligible for waitlisting; studying the impact of racism on outcomes alone is a hugely complex task as confounding variables such as medical factors and psychosocial determinants for health are difficult to accurately control for.…”

Deceased Donor Characteristics and Kidney Transplant Outcomes

“…While incorporating ethnicity into clinical decision-making can be considered a form of personalized medicine, it may not add additional value. For example, Chong et al, in an analysis of data from the United States between 2000–2017, demonstrated removal of donor ethnicity from KDRI calculations makes negligible difference to patient and kidney allograft survival, strongly advocating for removal of donor ethnicity as a risk factor ( 53 ).…”