Blacks Wait Longer for Kidneys : Transplants: When it comes to donor organs, two reports find a real disparity between the races, but uncover no evidence of prejudice.

ALBANY, N.Y. —  Two recent reports have concluded that blacks with kidney disease have to wait longer than white patients for transplants--if they get donor organs at all.

The experts say they aren’t certain if the disparity is due to racism, economics, genetics or some combination of factors. The federal Department of Health and Human Services’ inspector general says that a subconscious bias may be at work.

“There is certainly reason to believe that all racial bias has not been kicked out of our society yet,” said Mark Krushat, a statistician on the inspector general’s study of the transplant rate.

Kidney replacements account for three-quarters of all organ transplants in the United States; 84% of patients awaiting donor organs are in line for a kidney, the federal report said.

It said that black patients, on average, waited 13.9 months for replacement kidneys while the average white waited 7.6 months. Inspector General Richard Kusserow studied the 17,566 Americans whose names were on waiting lists for 18 months in the late 1980s.

A separate study conducted by the New York state Health Department recently found that a black with kidney disease was only 55% as likely as a white to get a transplant.

Nonetheless, New York and federal researchers said they uncovered no evidence of racial prejudice.

“My own personal view is if there is any role of bias, it’s an extremely small one. I’ve never encountered it,” said Dr. Jordan Cohen, medical school dean at the State University of New York at Stony Brook and author of the New York report.

For reasons not entirely clear, blacks are more susceptible to kidney disease than whites. Although just 12% of the U.S. population is black, a third of all patients undergoing dialysis are black, the inspector general noted.

And blacks, in general, tend to be more reluctant to donate organs than whites. When doctors approached the families of about 600 dying people in New York City from 1984 through 1987, 69% of the whites and 45% of the blacks agreed to donate kidneys to their relatives, according to the New York study.

Although a white person’s kidney can be transplanted to a black, differences in genetic factors and blood types make it easier to match organs between people of the same race, Krushat said.

In general, wealthier and better educated people tend to seek medical help for problems earlier, and are more likely to understand the concept of organ transplantation, Cohen said. This would tend to give whites an advantage over blacks as transplant candidates, he said.

Although federal Medicaid and Medicare programs will pay for transplants, poor people are still at a disadvantage because the federal subsidy programs cover medicines only for a year after the surgery, Krushat said. Expensive drugs are frequently needed longer by transplant patients.

Poor people thus tend to stay on dialysis longer so they can save extra money, he said. But the longer a patient is on dialysis, the slimmer are the chances for a successful transplant, he said.

“It’s a vicious cycle,” Krushat said.

The New York study found that the patients likely to receive a transplant were male, white and residents of affluent neighborhoods.

Still, the researchers said, those factors can’t explain the wide disparity between blacks and whites.

The federal report said the difference in waiting times between races tended to be the same for patients of all blood types and genetic make-ups, discounting those differences as a factor in the longer waiting times.

The American Medical Assn.’s Council on Ethical and Judicial Affairs said the different rates of kidney transplantation was an indication of disparities in medical treatment. The council, whose comments were included in the federal report, said it was unlikely that medical factors alone could account for blacks’ relative difficulty getting kidneys.

The federal study found that in New England and the Plains states, waiting times were about the same for blacks and whites. In all other regions, blacks waited longer than whites.

The studies indicated that the National Organ Transplant Act, passed by Congress in 1984, hasn’t resulted in a fairer distribution of organs, Krushat said. The legislation prohibits buying and selling organs. It set up a procurement network to promote fair distribution.

“Although great strides have been achieved, it’s not completely fair,” he said.

“It’s a human system,” Krushat added. “There’s no way you’re going to take that factor out of there entirely. If there is a doctor out there who is a racist, he can find a way around it.”