An effort to reverse harm linked to a racially biased test used in kidney assessments appears to be working, according to new research on U.S. transplant waiting lists. The policy began after the national transplant system ended use of the race-based test and directed hospitals to identify Black patients whose past records might have qualified them for transplant sooner. Researchers reported that the changes moved some candidates up on the waiting list and increased transplant rates for Black patients in the period immediately following the policy.
The biased test involved a race-based formula to calculate kidney function, using creatinine levels to estimate how quickly the waste compound is filtered from blood. Under the test, Black patients’ kidneys appeared healthier than they were, which delayed diagnosis of impending organ failure and referral for transplantation, according to the research description. The U.S. system’s policy response ordered hospitals to comb through medical records containing the long-ago biased findings so eligible Black patients could receive credit for time they had lost.
Researchers at Beth Israel Deaconess Medical Center, Brigham and Women’s Hospital and Boston Medical Center analyzed a database covering kidney transplants between January 2022 and June 2025, comparing transplant rates before and after the January 2023 policy change. The team reported in JAMA Internal Medicine that among more than 21,000 Black transplant candidates given waiting time modifications, the median gain was 1.7 years. The wait-time improvement mattered because the wait for a kidney transplant averages three to five years, and can run longer in some parts of the country.
In addition to the waiting time credit, the researchers reported changes in transplant rates. Black patients’ transplant rate rose right after the policy change, increasing by 5.3 transplants per 1,000 listings, before leveling off. During the study period, the overall kidney transplant rate increased, and the transplant rate for non-Black patients did not change significantly under the new policy, with white patients remaining the highest group, the researchers said.
The study’s findings also drew commentary from an external medical expert. Dr. L. Ebony Boulware of Wake Forest University School of Medicine, who was not involved in the study, wrote an accompanying commentary that urged similar efforts to mitigate harm from other erroneously race-based medical tests. In the commentary, she said the findings “suggest that improving transplant care for Black individuals did not harm individuals of other races.”
Dr. Rohan Khazanchi, of Brigham and Women’s Hospital and Boston Medical Center, who led the study, said the policy “hopefully helps move the needle toward equity,” according to an interview described in the report. The waiting-list credit did not automatically produce immediate transplants for everyone credited: the researchers reported that 7,484 of the candidates received a new kidney during the study period.
The researchers also examined why fewer people may have received the waiting time modifications than they expected. Khazanchi was surprised to find that less than 1 of 3 Black transplant candidates received wait-time modifications. He said one possibility was that some candidates were not diagnosed with kidney disease until their organs had already failed—an emergency that doctors describe as “crashing onto dialysis.” He also suggested that the ordered lookback required digging into older medical records, possibly across different health systems, and that some transplant centers may have had more resources than others to complete that work.
Even after the ordered lookback began in 2023, the report said Khazanchi advised that Black patients more recently added to the transplant list should still ask whether they may be eligible for similar adjustments. The researchers’ analysis, published in JAMA Internal Medicine, offered the first detailed look at how waiting-time credits tied to correcting a race-based test can affect transplant access and whether such changes shift outcomes across racial groups.
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