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Talking Health Equity

It’s no secret that there are far more people waiting on transplant lists than there are available organs to transplant. But imagine finding out that an outdated assumption based on race was a factor keeping you at the bottom of the list.

This is exactly what happened to some patients on the United Network for Organ Sharing (UNOS) list waiting for kidney transplants. The Organ Procurement and Transplantation Network (OPTN), which is managed by UNOS, administers the transplant system in the U.S. and maintains and updates transplant policies.

These policies dictate that candidates for organ transplant must meet certain criteria to be placed on the waiting list, and for kidney transplant patients, one of these is the result of a test called “eGFR.” eGFR calculates kidney function and considers age, sex, weight, and, until recently, race. The inclusion of race in this metric was based on outdated notions that assumed that the kidney function of Black patients was significantly different to that of other groups, often resulting in Black patients being placed lower on the list.

In 2020, the National Kidney Foundation and the American Society of Nephrology challenged the use of race in determining candidacy for transplants and declared that as a variable, race should not be applied to the selection process. OPTN implemented this change in January 2023 and as a result, more than 14,000 Black kidney transplant patients found themselves moved up the wait list.

This is just one example of inequity that has been ingrained in U.S. healthcare through systematic racism and bias. Racism clearly affects social determinants of health by throwing up barriers to education, safe housing, access to affordable healthcare, and the like.

Racism is a public health crisis. Racial and ethnic groups experience far worse health outcomes than their white counterparts across the spectrum of health specialties. For example, according to the Journal of the American Medical Association, maternal death rates doubled between 1999-2019 for historically underserved populations of Black Americans, Native Americans, and Alaskan Native people1. Black Americans had the highest mortality rate of all groups. Perhaps even more shocking, the Centers for Disease Control determined that from 2017-2019, four in five pregnancy-related deaths were preventable2.

The enormity of this situation makes the work we do even more important. Salud is committed to reducing health disparities by reducing the burden of healthcare costs on patients and increasing cash flow to hospitals so they can continue to provide services to diverse populations. Every person at Salud plays a vital role in ensuring fair and equitable access to healthcare for everyone, and we can be proud that we are part of the solution.

1 Fleszar LG, Bryant AS, Johnson CO, et al. Trends in State-Level Maternal Mortality by Racial and Ethnic Group in the United States. JAMA. 2023;330(1):52–61. doi:10.1001/ jama.2023.9043

2 (2022, September 19). Four in 5 pregnancy-related deaths in the U.S. Are preventable. Centers for Disease Control. Retrieved June 21, 2024, from releases/2022/p0919-pregnancy-related-deaths.html

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