Time to Abolish Metrics That Sustain Systemic Racism in Kidney Allocation

Abstract

This Viewpoint discusses how the Kidney Donor Profile Index (KDPI)in its current form is not fit to guide kidney allocation because it devalues organ donation by Black donors based on a weak association between donor race and kidney transplant failure.

Why all clinical guideline recommendations are ‘Conditional’

“…15 For example, attempts to remedy the disparity in treatment of patients with chronic kidney disease might actually increase the risk of poor clinical outcomes in certain populations. 16 Threats to health equity risk undermining public trust in healthcare and have been acknowledged in the guideline literature. 17 The 'Evidence-to-Decision (EtD)' framework, an initiative within the GRADE consortium, 18 is a noteworthy response to increased concerns regarding equity and complexity within the GRADE consortium.…”

“…Not only studies of COVID outcomes but also other research show the inherent complexity of the underlying factors 15 . For example, attempts to remedy the disparity in treatment of patients with chronic kidney disease might actually increase the risk of poor clinical outcomes in certain populations 16 . Threats to health equity risk undermining public trust in healthcare and have been acknowledged in the guideline literature 17 .…”

Integrating the patient voice: patient-centred and equitable clinical risk prediction for kidney health and disease

“…GFR estimating equations historically included a variable and correction factor for Black persons [15]; this inclusion resulted in higher GFR estimates for Black people [16], which might systematically delay important elements of kidney health management such as medications to slow progression or referral for specialized nephrology care or transplantation [14 ▪▪ ,17]. Similar considerations apply to the inclusion of race in metrics that influence acceptance and potentially allocation of donated kidneys [18]. In addition to this scientific rationale for exclusion of race in eGFR calculation, race is a social and not a biological construct, with evidence that people have just as much if not more genetic or biological diversity within a racial group as between groups [17].…”

Transforming Transplant in the United States

“…Policies that conflict with current science must also be reformed—such as ending the use of race, a social construct, in the algorithm that ranks and allocates kidneys, a step we commend OPTN for now undertaking. 9…”

“…Policies that conflict with current science must also be reformed—such as ending the use of race, a social construct, in the algorithm that ranks and allocates kidneys, a step we commend OPTN for now undertaking. 9 Establish transparency to improve access to transplant and reduce barriers in the kidney health ecosystem. Lack of transparency at every step in the transplant process makes navigating it difficult, exacerbating inequities and barriers.…”