Why the U.S. must improve health equity in kidney transplantation

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The U.S. has an equity problem in kidney transplantation, with great disparities among transplant rates for Black and Hispanic patients compared to white patients.

Why it’s important: Black patients make up 13% of the U.S. population but account for 35% of patients with kidney failure — and only 7% of this group receives a kidney transplant within three years of diagnosis. 

  • Additionally, kidney failure as a diagnosis among Hispanic individuals has increased by 70% over the past two decades.

Patients with kidney failure require a kidney transplant or dialysis — at least three times per week, up to four hours per treatment — to sustain life. 

  • Nearly 100,000 Americans are waiting for a kidney transplant.
  • And approximately 500,000 Americans receive dialysis today. 

The challenge: Dialysis patients of color are less likely to receive a kidney transplant. 

Regardless of their 23% higher rates of referral to transplant centers compared to white patients, Black patients are: 

  • 19% less likely to be listed for a transplant. 
  • 52% less likely to receive a transplant once waitlisted.

Data also show people of color are more likely to be under- or uninsured, including people covered under Medicare’s end-stage renal disease (ESRD) program that don’t have secondary coverage.

The idea: Improving health equity within kidney transplantation requires solutions and collaboration from policymakers and leaders across the kidney and transplant communities. 

In late 2020, Congress signed into law legislation, known as the “Immuno Bill”, that guarantees lifetime Medicare coverage of immunosuppressive drugs for kidney transplant recipients versus its current cap at three years. 

The Immuno Bill, which will go into effect in 2023, is a game-changer for patients with kidney failure and is poised to help address gaps in health disparities. 

The reason: Immunosuppressive drugs suppress a recipient’s immune system so the body doesn’t reject the new organ — skipping even one dose increases the likelihood of organ failure. 

  • But, many of these drugs are expensive for the uninsured as well as for insured patients due to high copays. 
  • Hundreds of people every year lose their kidney transplants and must return to dialysis because they cannot afford to cover the costs of these drugs on their own.
  • Many people never make it onto the transplant waitlist because it’s been determined that they wouldn’t be able to afford these drugs after getting a kidney.

Through the Immuno Bill, Medicare is set to save up to $73 million over a 10-year period as fewer transplant recipients return to dialysis. 

What you need to know: The Centers for Medicare & Medicaid Services recently finalized a rule that will give dialysis providers more flexibility and accountability to improve transplant rates among patients of color. 

  • This is one of the first CMS Innovation Center models to directly address health equity.
  • It rewards dialysis providers and clinicians for achieving higher kidney transplant rates among patients with lower socioeconomic status.

Next steps: Fixing immunosuppressive drug coverage is one of a few key ways to help improve health equity in transplantation in the U.S. But it’s not a silver bullet. There is more work to do.

Other longstanding biases and policies still hinder equitable access:

  • Studies have shown that there is an association between race and maintaining transplant waitlist status. 
  • In some communities with larger minority populations, average wait times are greater than five years for a deceased donor transplant compared to the average wait time of 3.6 years.
  • People of color are much less likely to receive a kidney from a living donor, which often lasts longer than a deceased organ and can mean better health outcomes. 

DaVita is committed to helping the transplant system overcome these health disparities by: 

  • Referring all patients interested in a kidney transplant to transplant centers, which are responsible for deciding if patients will be accepted for the waitlist. 
  • Collaborating with organizations like the National Kidney Foundation to pilot programs that will help close the living donor gap for communities of color. 
  • Funding new technologies that broaden access to post-transplant care, like Qsant’s at-home test to detect a kidney transplant’s risk of rejection — without an expensive, invasive biopsy.

Learn more about DaVita’s efforts to create an equitable future for kidney transplants.