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Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 2005 Feb;97(2):153–160.

Racial and ethnic disparities in renal transplantation.

Joanne M Churak 1
PMCID: PMC2568786  PMID: 15712778

Abstract

Racial and ethnic disparities exist in renal transplantation. The causes are multifactorial and include but are not limited to racism, socioeconomic status and class, unfavorable geographical location, lack of organ donation by minority groups, and differences in social networks, health beliefs culture and HLA typing. These disparities affect blacks, Hispanic Americans, Native Americans, Alaskan natiives and Asians. Elimination of these disparities is difficult, since many of the causes are intertwined, and it is difficult todiscern attributable disparity risk associated with the various factors. The possible solutions and recommendations are numerous. Since it is difficult to identify which may be successsful, thorough evaluation is required to determine which should be implemented. Some recommendations may not be easily implemented. Those selected for implementation must be continuously monitored for the expected results and effects.

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Selected References

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  1. Arthur Teri. The role of social networks: a novel hypothesis to explain the phenomenon of racial disparity in kidney transplantation. Am J Kidney Dis. 2002 Oct;40(4):678–681. doi: 10.1053/ajkd.2002.35672. [DOI] [PubMed] [Google Scholar]
  2. Ayanian J. Z., Cleary P. D., Weissman J. S., Epstein A. M. The effect of patients' preferences on racial differences in access to renal transplantation. N Engl J Med. 1999 Nov 25;341(22):1661–1669. doi: 10.1056/NEJM199911253412206. [DOI] [PubMed] [Google Scholar]
  3. Ayanian John Z., Cleary Paul D., Keogh Joseph H., Noonan Susan J., David-Kasdan Jo Ann, Epstein Arnold M. Physicians' beliefs about racial differences in referral for renal transplantation. Am J Kidney Dis. 2004 Feb;43(2):350–357. doi: 10.1053/j.ajkd.2003.10.022. [DOI] [PubMed] [Google Scholar]
  4. Bach Peter B., Pham Hoangmai H., Schrag Deborah, Tate Ramsey C., Hargraves J. Lee. Primary care physicians who treat blacks and whites. N Engl J Med. 2004 Aug 5;351(6):575–584. doi: 10.1056/NEJMsa040609. [DOI] [PubMed] [Google Scholar]
  5. Cecka J. M. The UNOS renal transplant registry. Clin Transpl. 2001:1–18. [PubMed] [Google Scholar]
  6. Feldman H. I., Klag M. J., Chiapella A. P., Whelton P. K. End-stage renal disease in US minority groups. Am J Kidney Dis. 1992 May;19(5):397–410. doi: 10.1016/s0272-6386(12)80945-0. [DOI] [PubMed] [Google Scholar]
  7. Gadegbeku Crystal, Freeman Michele, Agodoa Lawrence. Racial disparities in renal replacement therapy. J Natl Med Assoc. 2002 Aug;94(8 Suppl):45S–54S. [PMC free article] [PubMed] [Google Scholar]
  8. Garg P. P., Diener-West M., Powe N. R. Reducing racial disparities in transplant activation: whom should we target? Am J Kidney Dis. 2001 May;37(5):921–931. doi: 10.1016/s0272-6386(05)80007-1. [DOI] [PubMed] [Google Scholar]
  9. Gaston R. S., Ayres I., Dooley L. G., Diethelm A. G. Racial equity in renal transplantation. The disparate impact of HLA-based allocation. JAMA. 1993 Sep 15;270(11):1352–1356. [PubMed] [Google Scholar]
  10. Gaylin D. S., Held P. J., Port F. K., Hunsicker L. G., Wolfe R. A., Kahan B. D., Jones C. A., Agodoa L. Y. The impact of comorbid and sociodemographic factors on access to renal transplantation. JAMA. 1993 Feb 3;269(5):603–608. [PubMed] [Google Scholar]
  11. Gaylin D. S., Held P. J., Port F. K., Hunsicker L. G., Wolfe R. A., Kahan B. D., Jones C. A., Agodoa L. Y. The impact of comorbid and sociodemographic factors on access to renal transplantation. JAMA. 1993 Feb 3;269(5):603–608. [PubMed] [Google Scholar]
  12. Georgi B., Sumrani N., Maursky V., Hassoun A., Hong J. H., Yu L., JeanBaptiste F., Distant D. A., Mocerino M., Sommer B. G. Racial differences in long-term renal allograft outcome. Transplant Proc. 1996 Jun;28(3):1623–1625. [PubMed] [Google Scholar]
  13. Guadagnoli E., McNamara P., Evanisko M. J., Beasley C., Callender C. O., Poretsky A. The influence of race on approaching families for organ donation and their decision to donate. Am J Public Health. 1999 Feb;89(2):244–247. doi: 10.2105/ajph.89.2.244. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Held P. J., Pauly M. V., Bovbjerg R. R., Newmann J., Salvatierra O., Jr Access to kidney transplantation. Has the United States eliminated income and racial differences? Arch Intern Med. 1988 Dec;148(12):2594–2600. doi: 10.1001/archinte.148.12.2594. [DOI] [PubMed] [Google Scholar]
  15. Holley J. L., McCauley C., Doherty B., Stackiewicz L., Johnson J. P. Patients' views in the choice of renal transplant. Kidney Int. 1996 Feb;49(2):494–498. doi: 10.1038/ki.1996.70. [DOI] [PubMed] [Google Scholar]
  16. Hood R. G. Confronting racial and ethnic disparities in health care. Acad Med. 2001 Jun;76(6):584–585. doi: 10.1097/00001888-200106000-00006. [DOI] [PubMed] [Google Scholar]
  17. Hood R. G. Inaugural address: realizing the promise of health care equality: our leadership mandate for the new millennium. J Natl Med Assoc. 2000 Sep;92(9):417–423. [PMC free article] [PubMed] [Google Scholar]
  18. Hood R. G., Managed Care Fighting invisible barriers to equitable health care. Interview by Patrick Mullen. J Natl Med Assoc. 2001 Jun;93(6):197–200. [PMC free article] [PubMed] [Google Scholar]
  19. Isaacs R. B., Lobo P. I., Nock S. L., Hanson J. A., Ojo A. O., Pruett T. L. Racial disparities in access to simultaneous pancreas-kidney transplantation in the United States. Am J Kidney Dis. 2000 Sep;36(3):526–533. doi: 10.1053/ajkd.2000.9793. [DOI] [PubMed] [Google Scholar]
  20. Isaacs Stephen L., Schroeder Steven A. Class - the ignored determinant of the nation's health. N Engl J Med. 2004 Sep 9;351(11):1137–1142. doi: 10.1056/NEJMsb040329. [DOI] [PubMed] [Google Scholar]
  21. Kasiske B. L., London W., Ellison M. D. Race and socioeconomic factors influencing early placement on the kidney transplant waiting list. J Am Soc Nephrol. 1998 Nov;9(11):2142–2147. doi: 10.1681/ASN.V9112142. [DOI] [PubMed] [Google Scholar]
  22. Koyama H., Cecka J. M. Race effects. Clin Transpl. 1991:269–280. [PubMed] [Google Scholar]
  23. Lavizzo-Mourey Risa, Knickman James R. Racial disparities--the need for research and action. N Engl J Med. 2003 Oct 2;349(14):1379–1380. doi: 10.1056/NEJMe030090. [DOI] [PubMed] [Google Scholar]
  24. Levin A. Consequences of late referral on patient outcomes. Nephrol Dial Transplant. 2000;15 (Suppl 3):8–13. doi: 10.1093/oxfordjournals.ndt.a027977. [DOI] [PubMed] [Google Scholar]
  25. McNamara P., Guadagnoli E., Evanisko M. J., Beasley C., Santiago-Delpin E. A., Callender C. O., Christiansen E. Correlates of support for organ donation among three ethnic groups. Clin Transplant. 1999 Feb;13(1 Pt 1):45–50. doi: 10.1034/j.1399-0012.1999.t01-2-130107.x. [DOI] [PubMed] [Google Scholar]
  26. Narva Andrew S. The spectrum of kidney disease in American Indians. Kidney Int Suppl. 2003 Feb;(83):S3–S7. doi: 10.1046/j.1523-1755.63.s83.2.x. [DOI] [PubMed] [Google Scholar]
  27. Ozminkowski R. J., White A. J., Hassol A., Murphy M. Minimizing racial disparity regarding receipt of a cadaver kidney transplant. Am J Kidney Dis. 1997 Dec;30(6):749–759. doi: 10.1016/s0272-6386(97)90078-0. [DOI] [PubMed] [Google Scholar]
  28. Ozminkowski R. J., White A. J., Hassol A., Murphy M. What if socioeconomics made no difference?: access to a cadaver kidney transplant as an example. Med Care. 1998 Sep;36(9):1398–1406. doi: 10.1097/00005650-199809000-00011. [DOI] [PubMed] [Google Scholar]
  29. Powe Neil R., Boulware L. Ebony. The uneven distribution of kidney transplants: getting at the root causes and improving care. Am J Kidney Dis. 2002 Oct;40(4):861–863. doi: 10.1053/ajkd.2002.36562. [DOI] [PubMed] [Google Scholar]
  30. Powe Neil R. To have and have not: Health and health care disparities in chronic kidney disease. Kidney Int. 2003 Aug;64(2):763–772. doi: 10.1046/j.1523-1755.2003.00138.x. [DOI] [PubMed] [Google Scholar]
  31. Reddan D. N., Szczech L. A., Klassen P. S., Owen W. F., Jr Racial inequity in America's ESRD program. Semin Dial. 2000 Nov-Dec;13(6):399–403. doi: 10.1046/j.1525-139x.2000.00109.x. [DOI] [PubMed] [Google Scholar]
  32. Roberts John P., Wolfe Robert A., Bragg-Gresham Jennifer L., Rush Sarah H., Wynn James J., Distant Dale A., Ashby Valarie B., Held Philip J., Port Friedrich K. Effect of changing the priority for HLA matching on the rates and outcomes of kidney transplantation in minority groups. N Engl J Med. 2004 Feb 5;350(6):545–551. doi: 10.1056/NEJMoa025056. [DOI] [PubMed] [Google Scholar]
  33. Satcher D. Eliminating disparities, promoting partnerships. Mayo Clin Proc. 1999 Aug;74(8):838–840. doi: 10.4065/74.8.838. [DOI] [PubMed] [Google Scholar]
  34. Schneider Eric C. Measuring mortality outcomes to improve health care: rational use of ratings and rankings. Med Care. 2002 Jan;40(1):1–3. doi: 10.1097/00005650-200201000-00001. [DOI] [PubMed] [Google Scholar]
  35. Sumrani N., Delaney V., Hong J. H., Daskalakis P., Markell M., Friedman E. A., Sommer B. G. Racial differences in renal transplant outcome of insulin-dependent diabetic recipients in the cyclosporine era. ASAIO Trans. 1991 Jul-Sep;37(3):M304–M305. [PubMed] [Google Scholar]
  36. Whitehead M. The concepts and principles of equity and health. Int J Health Serv. 1992;22(3):429–445. doi: 10.2190/986L-LHQ6-2VTE-YRRN. [DOI] [PubMed] [Google Scholar]
  37. Wolfe R. A., Ashby V. B., Milford E. L., Bloembergen W. E., Agodoa L. Y., Held P. J., Port F. K. Differences in access to cadaveric renal transplantation in the United States. Am J Kidney Dis. 2000 Nov;36(5):1025–1033. doi: 10.1053/ajkd.2000.19106. [DOI] [PubMed] [Google Scholar]
  38. Wolfe William A., Toomey Evelyn. An evolving strategy to increase the number of minority and low-income patients referred for transplantation. Nephrol News Issues. 2004 Oct;18(11):52, 54-6. [PubMed] [Google Scholar]
  39. Young C. J., Gaston R. S. Renal transplantation in black Americans. N Engl J Med. 2000 Nov 23;343(21):1545–1552. doi: 10.1056/NEJM200011233432107. [DOI] [PubMed] [Google Scholar]
  40. van Ryn Michelle, Fu Steven S. Paved with good intentions: do public health and human service providers contribute to racial/ethnic disparities in health? Am J Public Health. 2003 Feb;93(2):248–255. doi: 10.2105/ajph.93.2.248. [DOI] [PMC free article] [PubMed] [Google Scholar]

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