Kidney allocation changes urged to cut disparities

African-Americans are less likely to be referred for a transplant and wait longer for a kidney once they're referred.

By Andis Robeznieks, AMNews staff. April 25, 2005.

Saying that a rare opportunity exists where "David can slay Goliath," surgeon Clive O. Callender, MD, is promoting a plan he believes will eliminate racial disparities in the nation's kidney transplant allocation system.

As the United Network for Organ Sharing goes through a top-to-bottom evaluation of its kidney allocation process, Dr. Callender, an African-American, is asking that it reconsider a proposal that the UNOS board rejected in November 2003: That patients are placed on the waiting list as soon as chronic maintenance dialysis starts.

UNOS has formed a Kidney Allocation Review Subcommittee that has stated that "everything is on the table" as it tries to find the perfect balance between giving everyone an equal chance at getting a kidney and making the best use of the kidneys available.

"That's the reason I'm here today," Dr. Callender told the panel at a March 11 public hearing. "Because you do listen and you are open to change."

Experts believe it's time to reassess how kidneys are allocated because there have been anti-rejection drug improvements and it is not as important to have a perfect match in order to perform a successful transplant.

Officials are trying to address acknowledged disparities based on blood type and geography, and to settle disagreements on basic issues such as allocating kidneys to the sickest patients first.

Some in the transplant community said allocating kidneys to the sickest patients first penalizes people who take steps to protect their health.