Black donors' kidneys are more likely to be discarded – bioethicist explains why

As one of Leading causes of death Kidney disease is a serious public health problem in the United States. The disease is particularly prevalent among black Americans. 3x chance They are more likely to develop kidney failure than white Americans.

Although blacks make up only 12% of the U.S. population, Accounting for 35% The proportion of people with kidney failure is due in part to the prevalence of diabetes and hypertension. Two major contributors Increased kidney disease in the black community.

largely 100,000 people There are 1,000 people waiting for a kidney transplant in the United States. Black Americans are more likely to need a transplant but are also less likely to receive one.

To make matters worse, the kidneys Black Donors In the United States, the result is more likely to be wasted A flawed system It mistakenly believes that kidneys from black donors are more likely to fail after transplant than kidneys from donors of other races.

As a scholar of bioethics, health, and philosophy, I believe this flawed system raises serious ethical concerns about justice, fairness, and appropriate stewardship of a scarce resource: kidneys.

How did we get here?

In the US organ transplant system, donor kidneys are used Kidney Donor Profile IndexThe algorithm includes 10 factors, including the donor's age, height, weight, and medical history of high blood pressure and diabetes.

Another factor in the algorithm is race.

investigate Previous porting It has been shown that some kidneys donated by black people are more likely to fail soon after transplant than kidneys donated by people of other races.

This will shorten the average length of time a transplanted kidney from a black donor lasts for a patient.

As a result, kidneys donated by black people High waste rate This is because the algorithm reduces quality based on the donor's race.

This means Good kidneys This could be wasteful and raises several ethical and practical concerns.

Risk, Race, and Genetics

Scientists are racial Social composition These are poor indicators of human genetic diversity.

By using donor race, it was assumed that people who belong to the same socially constructed group share important biological characteristics, despite evidence that there is more genetic variation. Within racial groups This is more pronounced among black Americans than among other racial groups.

The observed differences in outcomes may be due to genetics rather than race.

People who have two copies of a particular form APOL1 gene mutations You may be more likely to develop kidney disease.

About 85% of people with these mutations will not develop kidney disease, but 15% will. Medical researchers have yet to figure out what's behind this difference, but genetics is probably only part of it; the environment and exposure to certain viruses may also be explanations.

Those who have two copies More dangerous forms of the APOL1 gene Almost all of them have African ancestry, particularly West Africa and sub-Saharan Africa. In the United States, such people are typically classified as black or African American.

In a kidney transplant study, kidneys from donors with two high-risk APOL1 variants High failure rate Post-transplant, which may explain data on rates of kidney failure in black donors.

How might this practice change?

Healthcare professionals decide how to use and allocate limited resources, and with that comes an ethical responsibility to manage resources fairly and wisely, including preventing the unnecessary loss of transplantable kidneys.

Reducing the number of wasted kidneys is important for another reason.

Many people agree to donate their organs to help others. A black organ donor may feel uneasy knowing that their kidney will likely be discarded because it belongs to a black person.

Through this practice, Reduces trust Black Americans' lives are at risk in a health care system that has a long history of mistreating Black people.

Making organ transplants fairer Ignoring race As some medical researchers have suggested, when evaluating a donor kidney:

However, this approach fails to take into account observed differences in transplant outcomes and may result in transplantation of kidneys that are at increased risk of early failure due to genetic problems.

And black kidney transplant patients Kidneys from black donorsThis approach may perpetuate transplant disparities.

Another option to improve public health and reduce racial health disparities is to identify factors that lead to high rates of failure of some kidneys donated by black people.

One way researchers are working to identify high-risk kidneys is by: APOLLO StudyTo assess the impact of major mutations on the donated kidney.

In my view, using mutation rather than race could reduce the number of kidneys discarded while protecting recipients from kidneys that may fail soon after transplant.