*Black Americans who donate their kidneys are discovering a sad reality, with the donated body part ultimately being thrown away. More so than kidneys from nonblack donors.
In an article written by bioethicist Ana S. Iltis, the finding stems from what she described as a “flawed system that erroneously considers all Black donor kidneys as more likely to stop working after a transplant than kidneys from donors of other races.”
The educator noted the impact of kidney disease as one of the leading causes of death in the U.S, labeling it as a “serious public health problem.” One that affects black Americans in a major way.
The Conversation notes that Black Americans, who are three times more likely than white Americans to develop kidney failure. Despite making up only 12% of the U.S. population, Black people account for 35% of those with kidney failure. The partial reason for this can be traced to the prevalence of diabetes and high blood pressure – the two largest contributors to kidney disease – in the Black community.
Black people are among the almost 100,000 people in the U.S. who are awaiting kidney transplantation. Black Americans may be more likely to need transplants, but another reality check reveals they are also less likely to receive them.
And it doesn’t get any better. Ana S. Iltis goes on to voice her belief that the serious ethical concerns about justice, fairness, and good stewardship of a scarce resource – kidneys. are raised from the flawed medical system
“The U.S. organ transplantation system rates donor kidneys using the kidney donor profile index, an algorithm that includes 10 factors, including the donor’s age, height, weight and history of hypertension and diabetes,” Iltis wrote while bringing race into her argument and its factoring into how well kidneys function when they are donated by black people.
“Research on previous transplants shows that some kidneys donated by Black people are more likely to stop working sooner after transplantation than kidneys donated by people from other races.
This brings down the average time a transplanted kidney from a Black donor can last for a patient.
“As a result, kidneys donated by Black people are discarded at higher rates because the algorithm downgrades their quality based on the donor’s race,” she continued. “This means that some good kidneys may be wasted, raising several ethical and practical concerns.”
Although race is a notable factor in the perception of kidney transplantation, it may not be a total cause.
“It is possible that the explanation for observed differences in outcomes lies in genetics and not in race,” noted Iltis, a Wake Forest University-based professor. “People who have two copies of certain forms or variants of the APOL1 gene are more likely to develop kidney disease. About 85% of people with those variants never develop kidney disease, but 15% do. Medical researchers do not yet understand what is behind this difference, but genetics is likely only part of the story. Environment and exposure to certain viruses are also possible explanations.
As for the origin of the kidney disease situation, Iltis referenced Africa as the place where ancestors of people with dual copies of the APOL 1 gene’s riskier forms are located, particularly West and sub-Saharan Africa.
“In the U.S., such people typically are categorized as Black or African American, the educator stated. “Research on kidney transplants suggests that kidneys from donors with two copies of the higher-risk APOL1 variants fail at higher rates after transplantation. This could explain the data on Black donor kidney failure rate.”
For more of Iltis’ views on the failure of kidneys donated by black people, click the Conversation, here.
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