When Congress established it in 1984, the Organ Procurement and Transplantation Network was given a key mandate: set up a system to handle the growing demand for organ transplants that would efficiently match donors and recipients. and prevent human organs from being bought and sold.
In turn, OPTN created a nonprofit organization, United Network for Organ Sharing — that has run the program since 1986.
But for decades doctors used a race-based calculation that caused Black kidney patients to be less likely to be referred for a transplant evaluation — and more likely to remain on waiting lists longer than whites.
Now, however, an unprecedented effort to right that historic wrong seems to be working.
Credit Given for Extended Waiting Time
According to a study published Monday, thousands of Black patients waiting for kidney transplants have been given credit for lost time and moved up the transplant waiting list after the transplant system stopped using the test.
The medical journal JAMA Internal Medicine, which published the study, found that the positive results from the move could have broader implications for a field that has struggled with racial inequity.
“These findings provide evidence that remedying the harms of race-based medicine may be a promising approach to address racial kidney transplant inequities,” the researchers wrote.
But Dr. Deidra Crews, a nephrologist and deputy director of the Johns Hopkins Center for Health Equity, was more succinct: “There is no biological basis to race.”
“Race is a social construct,” Crews, president of the American Society of Nephrology, said in a news article published by Johns Hopkins Medicine. “There’s no blood test that you could do and then come away and say, ‘She’s a Black person.’”
Because of the disconnect between society and science, “A lot of people have been concerned that we were using this social construct of race in a way that had biologic consequences,” Crews said.
The U.S. transplant system formally ended the use of race-based kidney function calculations in 2022, and subsequently began implementing corrective policies. That involved reviewing cases to adjust waiting-list time for Black patients. Hospitals were required to determine which Black patients on their transplant lists could have qualified for a new kidney sooner and to credit them for that time.
The researchers analyzed a database of all kidney transplants between January 2022 and June 2025. When comparing transplant rates before and after the policy change, they found that among the more than 21,000 Black transplant candidates whose waiting time was modified the median gain was 1.7 years.
The National Kidney Foundation says the average waiting time for a kidney transplant is three to five years, but it can be far longer in different parts of the country. By ending the race-based test some patients may have their waiting time cut almost in half.
A Race-Based Misconception
The calculation was based on the incorrect assumption that Black people have more muscle mass, indicating a less advanced stage of kidney disease than in non-Black patients.
Since 2023, at least 10 people have sued UNOS for using the racist-based calculation. Last September, a federal judge rejected UNOS’s attempt to dismiss the lawsuits of patients suing the nonprofit organization for harm the race-based and unscientific calculation caused them.
In allowing the case to go forward, the judge ruled that allegations made by plaintiffs Deon Santos and Mark Thompson constituted racial discrimination.
As of 2023, nearly 37 million Americans have chronic kidney disease, meaning millions of Black Americans are affected, according to the Centers for Disease Control and Prevention.
As many as 9 in 10 adults don’t know they have the disease, including 1 in 3 adults with severe CKD.
Roughly 90,000 Americans who have end-stage kidney disease were waiting for a transplant as of late 2024.
Black candidates make up roughly 30% of the waiting list.
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