The Wall Street Journal on Friday examined the obstacles some African Americans face in obtaining donor kidneys for transplants and some of the solutions the United Network for Organ Sharing has enacted to address the situation. African Americans have a rate of kidney disease four times that of whites and make up 37% of the people receiving dialysis. However, they received only 18% of donated kidneys in 2001, according to the latest federal figures. Thirty-five percent of Americans on the national kidney transplant waiting list are African-American, and their median wait-time on the list is 4.7 years, compared with 2.2 years for whites. In addition, many African Americans join the list at a later stage of their disease or never join the list at all. African Americans face a number of obstacles when trying to obtain a donor kidney, and the gap between transplant rates for African Americans and whites cannot "be explained by differences in ability to pay," as people with kidney failure are eligible for Medicare coverage for transplants, the Journal reports. Surveys have shown that African Americans are more reluctant to undergo a transplant than whites, and when they do consent to go on the waiting list, they are more often told they are ineligible due to higher rates of obesity, high blood pressure and diabetes, according to the Journal. Healthy African Americans are also less likely to be referred to the transplant list and 44% less likely to complete all the steps to be included in the list if referred by a care provider. Some African Americans attribute such lower statistics of organ transplants to "racial bias -- conscious or unconscious" -- on the part of doctors, the Journal reports. According to John Ayanian, an associate professor of health care policy at Harvard Medical School, doctors sometimes have a "[p]reconceived perception that blacks are not interested in kidney transplants." Some doctors also might be influenced by the statistic that only 57% of kidneys transplanted in African Americans are still functioning five years after surgery, compared with 69% for whites. Researchers do not know the reason for that disparity. African Americans also less commonly receive kidneys from live donors than whites, in part because many African Americans are reluctant to ask family members for a donation.

Solutions
To address the racial disparity related to kidney transplants, experts have devised a number of solutions. For example, UNOS has changed the waiting-list rules to try to give more kidneys to African Americans -- in part by loosening the restrictions on protein-matching requirements for donor organs and recipients. Antirejection drugs have made compatibility a less important issue in transplants, according to the Journal. The Journal notes, however, that because of genetics, African Americans are more likely to reject kidneys donated by whites. In the first eight months after the rule change, 2,213 kidneys were transplanted into minorities -- mostly African Americans -- up 9.7% from the prior eight months. At the same time, 5.5% fewer whites received kidney transplants. Researchers say the initial improvement might be attributable in part to a backlog of African Americans who had been waiting for transplants, but they still "expect a significant long-term benefit for African Americans," according to the Journal. Other efforts that seek to reduce the racial disparities in kidney transplants include encouraging more African Americans to donate kidneys, which has increased the percentage of kidneys donated by African Americans from 9.5% in 1988 to 13% today. Another UNOS proposal that is being tested in several areas of the United States would count time spent on the waiting list based on how long a person has been on dialysis, instead of by when the person signed up for the list (Johannes, Wall Street Journal, 6/18).