Black patients with kidney disease want transplants; more Black surgeons may help
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As two Black physicians, we have spent most of our careers either in labs, operating rooms or classrooms trying to improve health care and save lives through science and education.
During the years, as we moved up in our professions — and still today — we have seen too few of our colleagues who look like us. Too often, we are the only Black medical professionals in the room, the only Black physicians thinking about how our scientific work will either positively or negatively impact those in our community.
We know numbers and data are impartial — absent of feelings, sympathy and empathy — but the people who use data can be swayed by conscious and unconscious biases and racism. It is the responsibility of physicians, scientists, researchers and the public to scrutinize data and ask questions.
In research on organ transplants, for example, our data led us to ask: Why do Black surgeons represent 5.5% of the transplant community in the U.S.? Why do Black Americans make up 28% of the wait list for all organs, but account for 16% of deceased donors? Why until recently were medical students still learning outdated and biased race-based kidney testing, like the eGFR, when it negatively impacts Black patients?
Kidney disease risk
Black Americans carry the burden of being diagnosed with kidney disease more frequently compared with other people of color. We can cite statistics linking kidney failure to other chronic diseases that are more prevalent among African Americans. Data show one in nine Black American adults have diabetes compared with one in 13 white Americans. But this finding does not provide the full context for this complex issue. To truly understand and fix the problem, we must connect the dots, study the patterns and find solutions. We must do the hard and uncomfortable work of scrutinizing our health care and education systems to find our answers and create our path forward.
Together, we have held a magnifying glass to the medical education system and asked: What is missing in the education of Black children who more do not pursue careers in medicine to serve the communities so desperately in need? And what is our health care system actively doing to create more Black health care workers in organ donation and all other specialties?
While our historically Black colleges and universities (HBCUs) alone cannot fix these issues, we have begun trying to solve them. Earlier this year, six students from Meharry Medical College — one of only four historically Black academic and health science centers in the United States — spent 8 weeks at Tennessee Donor Services (TDS) in Nashville, Tennessee, learning how organ procurement organizations (OPOs) make transplant surgery possible. This pilot program is part of a first-of-its-kind partnership between the Consortium of HBCU medical schools, the Association for Organ Procurement Organizations (AOPO) and the Organ Donation Advocacy Group (ODAG) that looks at new ways to diversify the pipeline of Black professionals in organ donation. It was transformative for the students and the OPOs.
The students assisted with finding eligible donors, supported grieving families through donation, recovered organs and connected the organs to recipients across the United States. The summer program exposed HBCU medical students to opportunities within the organ donation specialty during the beginning of their medical education, when they have yet to decide their chosen career paths in health care.
We strongly believe students can only get excited about what they experience. This novel program is putting more Black and historically underrepresented students in operating rooms beside transplant surgeons with a scalpel in hand — and it is putting more students in labs examining data that could impact the lives of patients. The Meharry students cared for organ donors and walked with their family members through the process of donation. They learned about a segment of health care in which students who look like them are rarely present. Hands-on experiences like this are how we start to better diversify the specialty.
Early education
But the work should not just begin when they enter medical school. We must also prioritize engaging with young Black learners as early as possible to get them interested in health careers — particularly in organ donation. As part of the HBCU-OPO partnership, Howard University partnered with its local OPO, Infinite Legacy, to create a series of videos for elementary and middle school students that explore organ donation and transplantation. The videos discuss donation and transplantation careers in approachable and age-appropriate ways. The videos were piloted in Washington, D.C. schools this spring and have become the basis of a four-part curriculum to be deployed at a Washington, D.C. middle school beginning in January 2024.
The curriculum focuses on introducing students to organ donation, tackling myths, supporting organ donation and seizing opportunities within the specialty — and even includes a pep rally and a field trip to Infinite Legacy.
Programs like these can reconfigure the health care system to serve all and employ all — not just the few. Charles R. Drew University of Medicine and Science and Morehouse School of Medicine both are developing programs, expected to roll out next year, to complement the work being done by Howard and Meharry. The task ahead is large, but HBCUs have never shied away from a challenge. We know the strides made will ultimately impact those who need it most — the under-resourced and underserved.
As leaders who have inherited education and health care systems riddled with inequities, disparities and racism, it is incumbent upon us to actively improve both systems. We did not ask for broken structures, yet here we are. All of us must ask: What am I doing to make the process better for all? What haven’t I tried? What might work?
We know that Black patients fare better when their physicians look like them and have a deeper cultural link. We need to seek out and train the Black physicians, nurses, researchers, technicians and administrators we desperately need to have a better health care system. We call on our peers to apply all their creativity, ingenuity, collaboration and courage to finally break through the logjam of inequity.
- For more information:
- James E.K. Hildreth Sr., PhD, MD, is president and CEO of Meharry Medical College. He was named to President Biden’s Health Equity Task Force in 2021. He can be reached at officeofthepresident@mmc.edu.
- Clive O. Callender, MD, FACS, is a professor of surgery at Howard University College of Medicine in Washington, D.C. In 1991, Callender conceptualized and founded the National Minority Organ Tissue Transplant Education Program for the purpose of increasing minority donation rates nationally. He can be reached at ccallender@Howard.edu.
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