The Teen Would Be on the Transplant List —If He Were White

A look into how race factors in to when patients get on the kidney transplant list
By Kate Seamons,  Newser Staff
Posted Jul 10, 2021 4:20 PM CDT
The Teen Would Be on the Transplant List —If He Were White
Writes Tsai of Jordan's grandmother: "She cackles at the idea that while Arnold Schwarzenegger's lab work will remain unadjusted for increased muscle, Jordan's will be recalculated for brawn. 'Let me tell you,' she laughs, 'this kid looks like a sewing needle.'"   (Getty Images)

"I was immediately taken by Jordan's story," writes Jennifer Tsai, who has been an emergency medicine physician for two years. "It's an illuminating example of how racism is alive and burrowed within medicine." And so in a lengthy piece for Slate she shares it, taking a deep dive into the situation that got Jordan Crowley to age 18 with a single withered kidney and no place, yet, on the transplant list. The upshot: race. Crowley was born with that one kidney, and according to doctors, his current estimation of glomerular filtration rate, or eGFR, is 21. The eGFR has since 1999 been the accepted measure for determining a patient's level of kidney disease, and in the US, once you get below 20, you can get your name on the transplant list. Thing is, the eGFR calculation takes race into account.

If Jordan, who is biracial (he has one Black grandparent and three white ones) had his eGFR calculated on the scale for white people, his would be 17. But the doctors who conducted Jordan's first transplant evaluation years ago, "in a disturbing echo of the 'one drop' rule," writes Tsai, determined he was Black. The scale for Black patients assumes they have naturally higher levels of creatinine; high levels indicate the kidneys aren't functioning well, so the eGFR model included the recommendation that doctors up the eGFR of Black patients by 21%. "Kidneys," points out Tsai, "are not white or Black. There are, in fact, no genes, physiologic traits, or biological characteristics that distinguish one race from another." One study found that if the race adjustment was done away with, a third of Black patients would level up to a more severe class of kidney disease, opening their access to not just transplants but care. The rub: there's a more accurate and race-blind way to test for kidney function, it's just more expensive—$2, versus $0.02. (We highly recommend you read the full article.)

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