The policy change followed years of concern over an equation used to calculate kidney function that adjusted results for Black patients based on a long-debunked theory about biological differences. That adjustment made their kidneys appear healthier than they actually were, delaying referrals for transplant and exacerbating existing disparities.
Black Americans are over three times more likely than white people to experience kidney failure and comprise about 30% of the transplant waiting list. The biased test compounded other barriers to care.
Researchers found that less than one-third of Black transplant candidates received waiting time modifications. Dr. Rohan Khazanchi of Brigham and Women’s Hospital and Boston Medical Center, who led the study, suggested some patients were not diagnosed until their kidneys had failed, while others may have been missed due to inconsistent access to historical medical records across different health systems.
The study, published in JAMA Internal Medicine, showed that while the transplant rate for Black patients increased after the policy change, the overall kidney transplant rate rose during the study period and the rate for non-Black patients remained stable.
Dr. L. Ebony Boulware, who wrote an accompanying commentary, urged similar efforts to address harm from other race-based medical tests. Khazanchi said the policy “hopefully helps move the needle toward equity.”
The U.S. transplant system ordered the lookback in 2023, and Black patients added to the list more recently should inquire about eligibility for waiting time credits, Khazanchi advised.