Winston-Salem (USA), As a leading cause of death in the USA, kidney disease is a serious public health problem. The disease is particularly severe among black Americans, who are three times more likely than white Americans to develop kidney failure.
While blacks make up only 12 percent of the U.S. population, they account for 35 percent of people with kidney failure. The reason is partly due to the prevalence of diabetes and high blood pressure (the two main contributors to kidney disease) in the black community.
Nearly 100,000 people in the United States are waiting for a kidney transplant. Although African Americans are more likely to need transplants, they are also less likely to receive them. To make matters worse, kidneys from black donors in the United States are more likely to be discarded as a result of a flawed system that wrongly considers all kidneys from black donors are more likely to stop working after a 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, equity, and good stewardship of a scarce resource: kidneys.
How did we get here? The US organ transplant system classifies donor kidneys using the Kidney Donor Profile Index, an algorithm that includes 10 factors, including age, height, weight and history of hypertension and diabetes of the donor.
Another factor in the algorithm is race.
Research on past transplants shows that some kidneys donated by black people are more likely to stop working sooner after transplant than kidneys donated by people of other races. This reduces the average time a kidney transplanted from a black donor can last. for a patient.
As a result, kidneys donated by black people are discarded at a higher rate because the algorithm degrades their quality based on the race of the donor.
This means that some good kidneys may be wasted, raising several ethical and practical concerns.Risk, race and genetics.
Scientists have shown that races are social constructs that are poor indicators of human genetic diversity.
Using a donor's race assumed that people belonging to the same socially constructed group share important biological characteristics despite evidence that there is more genetic variation within racial groups than between other racial groups. This is the case for African Americans. It is possible that the explanation for the observed differences in results lies in genetics and not race.
People who have two copies of certain forms or variants of the APOL1 gene are more likely to develop kidney disease.
About 85 percent of people with those variants never develop kidney disease, but 15 percent do. Medical researchers still don't understand what's behind this difference, but genetics is likely only part of the story. Environment and exposure to certain viruses are also possible explanations. Almost all people who have two copies of the riskiest forms of the APOL1 gene have ancestors who came from Africa, especially Western and sub-Saharan Africa. In the United States, these people are usually classified as black or African American.
Kidney transplant research suggests that kidneys from donors with two copies of the higher-risk APOL1 variants fail at higher rates after transplant. This could explain the data on the rate of kidney failure in black donors.
How could this practice change? Health professionals decide how limited resources are used and distributed. This carries with it the 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 accept organ donation to help others. Black donors may be disturbed to learn that their kidneys are more likely to be discarded because they come from a Black person. This practice may further diminish African Americans' trust in a health care system that has a long history of mistreating donors. blacks.
Making organ transplantation more equitable could be as simple as ignoring race when evaluating donor kidneys, as some medical researchers have proposed.
But this approach would not take into account the difference seen in transplant outcomes and could result in transplanting some kidneys that are at higher risk of early failure due to a genetic problem. And since recipients of black kidneys are more likely of receiving kidneys from Black donors, this approach could perpetuate transplant disparities.
Another option that would improve public health and reduce racial health disparities is to identify factors that lead some kidneys donated by Black people to fail at higher rates.
One way researchers are working to identify higher-risk kidneys is by using the APOLLO study, which evaluates the impact of key variants on donated kidneys. In my opinion, using variant instead of race would likely decrease the number of wasted kidneys and at the same time would protect recipients from kidneys that are likely to stop functioning sooner after transplant. (The conversation) NPK
NPK
While blacks make up only 12 percent of the U.S. population, they account for 35 percent of people with kidney failure. The reason is partly due to the prevalence of diabetes and high blood pressure (the two main contributors to kidney disease) in the black community.
Nearly 100,000 people in the United States are waiting for a kidney transplant. Although African Americans are more likely to need transplants, they are also less likely to receive them. To make matters worse, kidneys from black donors in the United States are more likely to be discarded as a result of a flawed system that wrongly considers all kidneys from black donors are more likely to stop working after a 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, equity, and good stewardship of a scarce resource: kidneys.
How did we get here? The US organ transplant system classifies donor kidneys using the Kidney Donor Profile Index, an algorithm that includes 10 factors, including age, height, weight and history of hypertension and diabetes of the donor.
Another factor in the algorithm is race.
Research on past transplants shows that some kidneys donated by black people are more likely to stop working sooner after transplant than kidneys donated by people of other races. This reduces the average time a kidney transplanted from a black donor can last. for a patient.
As a result, kidneys donated by black people are discarded at a higher rate because the algorithm degrades their quality based on the race of the donor.
This means that some good kidneys may be wasted, raising several ethical and practical concerns.Risk, race and genetics.
Scientists have shown that races are social constructs that are poor indicators of human genetic diversity.
Using a donor's race assumed that people belonging to the same socially constructed group share important biological characteristics despite evidence that there is more genetic variation within racial groups than between other racial groups. This is the case for African Americans. It is possible that the explanation for the observed differences in results lies in genetics and not race.
People who have two copies of certain forms or variants of the APOL1 gene are more likely to develop kidney disease.
About 85 percent of people with those variants never develop kidney disease, but 15 percent do. Medical researchers still don't understand what's behind this difference, but genetics is likely only part of the story. Environment and exposure to certain viruses are also possible explanations. Almost all people who have two copies of the riskiest forms of the APOL1 gene have ancestors who came from Africa, especially Western and sub-Saharan Africa. In the United States, these people are usually classified as black or African American.
Kidney transplant research suggests that kidneys from donors with two copies of the higher-risk APOL1 variants fail at higher rates after transplant. This could explain the data on the rate of kidney failure in black donors.
How could this practice change? Health professionals decide how limited resources are used and distributed. This carries with it the 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 accept organ donation to help others. Black donors may be disturbed to learn that their kidneys are more likely to be discarded because they come from a Black person. This practice may further diminish African Americans' trust in a health care system that has a long history of mistreating donors. blacks.
Making organ transplantation more equitable could be as simple as ignoring race when evaluating donor kidneys, as some medical researchers have proposed.
But this approach would not take into account the difference seen in transplant outcomes and could result in transplanting some kidneys that are at higher risk of early failure due to a genetic problem. And since recipients of black kidneys are more likely of receiving kidneys from Black donors, this approach could perpetuate transplant disparities.
Another option that would improve public health and reduce racial health disparities is to identify factors that lead some kidneys donated by Black people to fail at higher rates.
One way researchers are working to identify higher-risk kidneys is by using the APOLLO study, which evaluates the impact of key variants on donated kidneys. In my opinion, using variant instead of race would likely decrease the number of wasted kidneys and at the same time would protect recipients from kidneys that are likely to stop functioning sooner after transplant. (The conversation) NPK
NPK
