Report recommendations offer ways to reduce inequities in transplantation
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When lives hang in the balance, trust is essential. People of color have been chronically under-represented in our nation’s organ transplant system, to the detriment of their health.
Today, organizations across our transplant system are working to change this shortcoming with the direction of the National Academies of Science, Engineering and Medicine (NASEM) report on organ transplant system equity.
It is proven that many patients feel most comfortable when treated by physicians who share their backgrounds, particularly for procedures as complex as organ transplants. Today, only 7% of nephrologists and 5.5% of transplant surgeons are Black, furthering generational mistrust of the medical establishment. This research shows that Black and Hispanic patients are less likely than white patients to be preemptively listed for kidney transplants. Increasing workforce diversity throughout the system will encourage patients to seek lifesaving surgeries and receive the follow-up care they need to stay healthy.
Equity and donation
Equity and representation are also critical when individuals contemplate registering as organ donors and families weigh the decision to donate their relative’s organs. According to HHS, Black and Asian Americans have the lowest donor registration rates compared with other racial and ethnic groups. Consider that 60% of the more than 100,000 Americans waiting to receive transplants are people of color but represent only 29% of organ donors. The lack of trust and insufficient information in the health care system are systemic factors that contribute to the shortage of donors.
The NASEM report calls on HHS and stakeholders – organ procurement organizations (OPOs), transplant centers and donor hospitals – to eliminate disparities within the United States’ organ transplant system in the next 5 years in pursuit of achieving equity. This includes addressing inequities based on race and ethnicity, gender, geographic location, socioeconomic status, disability status and immigration status. NASEM calls for including patients in decision-making, more robust public education and amplifying the voices of those facing disparities.
Empowering patients with knowledge, and accurate public donor education are the priorities of the NASEM recommendations. Patients on the waitlist should be involved in their treatment and informed about organ offers.
Along with achieving equity, the NASEM report has flagged the underuse of donated organs as a key area for systemwide improvement. Evidence shows that many unused organs are viable, including many of the 20% of donated kidneys that are declined for transplant each year. This is concerning, as last year more than 7,600 kidneys were authorized for donation, recovered but ultimately not transplanted.
Fragmented system
Despite being the most successful organ transplant system in the world, our current operations are fragmented. The NASEM report aims for full integration of all aspects of the organ transplant process, from setting performance goals to policymaking, and from modernizing information technology to adding donor care units.
Organ donation, with its life-saving power and unifying potential, belongs to everyone. Working together, we will ensure that all Americans receive the care and achieve the representation they deserve.
- References:
- Carlton A, et al. Fix inequity of Black people being overrepresented on organ transplant waitlists | Opinion. The Tennessean. Sept. 19, 2022. https://www.tennessean.com/story/opinion/contributors/2022/09/19/organ-transplants-black-patients-overrepresented-waitlists/10370440002/. Published Sept. 19, 2022. Accessed Oct. 9, 2023.
- National data, waiting list removals, kidney, registrations, removal reasons by year. Organ Procurement & Transplantation Network. https://optn.transplant.hrsa.gov/data/view-data-reports/national-data/. Accessed Oct. 10, 2023.
- Organ donation and African Americans. https://minorityhealth.hhs.gov/organ-donation-and-african-americans. HHS Office of Minority Health. Accessed Oct. 9, 2023.
- Realizing the promise of equity in the organ transplantation system. https://nap.nationalacademies.org/read/26364/chapter/1#ii National Academies of Science, Engineering and Medicine. 2022. pp. 89,103-131.
- For more information:
- Colleen McCarthy is the president of the Association of Organ Procurement (AOPO) and chairs the AOPO board of directors. McCarthy also serves as the vice president of Organ and Tissue Donation at Versiti Blood Center of Wisconsin. She can be reached at aopo@aopo.org.
- Mark Tudor is the past president of the Association for Multicultural Affairs in Transplantation and CEO of the Arkansas Regional Organ Recovery Agency. He can be reached at administration@amat1.org.
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