A new rule proposed by the Biden Department of Health and Human Services intends to increase access to kidney transplants for all people with end-stage renal disease by reducing racial disparities among Black patients.
HHS Secretary Xavier Becerra lauded the rule, which would be implemented through HHS’ Centers for Medicare & Medicaid Services (CMS).
Mr. Becerra said in a statement that the organ transplant industry “is not immune to racial inequities” and that “Black Americans disproportionately struggle with life-threatening kidney disease, yet they receive a smaller percentage of kidney transplants.”
“The Biden-Harris administration is taking concrete steps to remove racial bias when calculating wait times and rooting out profiteering and inequity in the transplant process,” he said.
In 2021, 32% of kidney patients on a national waitlist were Black, but only 13.5% of recipients of a transplant from a living donor were Black, according to the Scientific Registry of Transplant Recipients Annual Data Report. White patients made up 35.8% of the waitlist and 61.8% of transplant recipients from a living donor, according to HealthCareFinanceNews.com.
The proposed HHS rule came weeks after over 14,000 Black kidney transplant candidates were moved up on the waitlist when it was discovered that an outdated medical test may have inappropriately calculated their necessity for a transplant.
Opponents of the proposed rule say the administration is unfairly blaming physicians for not extending the opportunity for kidney transplants to Black patients.
Dr. Stanley Goldfarb, board chairman of Do No Harm, an organization representing health care workers and policymakers focused on keeping identity politics out of health care, attributes other reasons for the lower percentage of kidney transplants for Black patients.
Dr. Goldfarb said kidney transplants come either from donors who are about to die or just died, or from relatives or friends who donate if they are matches.
“The first problem is the Black community tends to be very low on the donation rate,” Dr. Goldfarb said.
But Sen. Cory A. Booker, New Jersey Democrat, noted in a letter to Mr. Becerra in November 2022 that a federal study found “health care providers were less likely to perceive Black families that wanted to donate and [organ procurement organizations] were more likely to not have spoken to Black families.” Mr. Booker urged the administration to make the system of organ donation and transplantation more equitable.
Dr. Goldfarb also said the waiting list’s obstacles mimic the rigorous schedule of commitment necessary from a kidney patient for a successful transplant operation.
“To maintain [the transplant], you have to take medications on a highly rigorous schedule,” he said. “If you miss a dose here and there, you could end up losing your kidney.
“The way they’ve decided patients would be motivated is to have the ability to get on the transplant list to be an opt-in mechanism,” he said.
Dr. Goldfarb said other barriers include a potential cardiac catheterization to ensure that a patient’s heart is strong enough to endure kidney transplant surgery.
According to CMS, the Increasing Organ Transplant Access Model would be a mandatory six-year model that aligns with wider efforts “to improve equitable access to organ transplants, improve accountability in the U.S. organ transplantation system and increase the availability and use of donated organs.”
Ninety out of the 257 transplant hospitals in the country would be required to participate in the proposed six-year model beginning Jan. 1, 2025.
CMS is proposing the model through rule-making and is currently seeking public comment.