Mass General Transplant Center Addresses Health Disparities in the Kidney Transplant Process

As a leading transplant center in Region 1 (which includes the New England states, with the exception of the western half of Vermont), the Mass General Transplant Center is committed to providing equitable access to transplantation for all of our patients. We understand that the journey from referral to kidney transplantation can be challenging, especially for patients who identify as Black or African American.

In the past, the calculation of the estimated glomerular filtration rate (eGFR) for Black individuals could result in an overestimation of kidney function, which could delay their disease stage identification, treatment, and listing for transplantation. This potential miscalculation could result in longer wait times on the national deceased donor waitlist, and as a result, lower transplant rates for Black patients.

As of July 2022, the United Organ Sharing Network (UNOS) has removed the race variable in the eGFR calculation, making it race-neutral. UNOS, which serves as the Organ Procurement and Transplant Network (OPTN) in the United States, has now released a new policy ensuring patients who identify as Black and were affected by the prior, race-inclusive eGFR calculation receive credit for increased time on the transplant waitlist. This will help to improve their position on the list for a kidney transplant.

The need for this policy is underscored by recent statistics. Black patients are nearly four times more likely to develop chronic kidney disease and often have a more aggressive progression to end-stage kidney disease compared to their white counterparts. Furthermore, in New England, the average wait time on the deceased donor waitlist for Black patients is nearly two years longer in comparison. Additionally, Black patients are referred to transplantation at a significantly lower rate than their white counterparts. When they are referred, they face higher rates of program denials based on program-specific criteria, further compounding the disparity in kidney transplantation rates.

How does the Mass General Transplant Center aim to address these disparities and implement the new UNOS policy? We have established the Equity in Kidney Transplantation (EqKT) Initiative wherein we work to improve health literacy, address health-related social needs, and provide support to historically disadvantaged patient populations, which includes those from Black, Indigenous, and Hispanic communities. Also, the kidney transplant program care teams are actively reviewing our waitlist of more than 1,300 patients, identifying those who can benefit from this policy update. Additionally, we plan to collaborate with our care partners to collect the first recorded race-neutral eGFR of 20 mL/min/1.73 m2 as well as the date it was obtained for our referred patients who identify as Black. We can then use that race-neutral eGFR as the corrected wait time start date on the UNOS deceased organ donor waitlist whenever appropriate.

At the Mass General Transplant Center, we strive to provide world-class patient care to all, and believe that every patient deserves equitable access to transplantation. We are proud to take these important steps to address health disparities and improve access and outcomes for our kidney transplant candidates.