Study says racial segregation hurts patients’ access to kidney transplants

Black and White patients face significant disparities in access to kidney transplants depending on whether their residential neighborhoods and transplant centers were racially segregated, a recent study has found.

The study, published in JAMA Internal Medicine, looked at 162,587 first-time live-donor kidney transplantation candidates in the national transplant registry from January 1995 through December 2021. Participants were tracked for an average of 1.9 years.

Among those patients, 49.2 percent were Black and 50.8 percent were White. The researchers matched the Zip codes of the candidates to Census Bureau data reflecting the racial diversity (or lack thereof ) of their neighborhoods.

Black candidates living in high-segregation neighborhoods had 10 percent lower access to live-donor kidney transplantation than their Black peers living in low-segregated areas, the data showed.

Overall, 7.1 percent of Black candidates in segregated neighborhoods received a live kidney transplant over a three-year period, while 9 percent of their Black counterparts in less segregated areas received a transplant. The percentage of White candidates who received similar transplants was similar in highly segregated neighborhoods and more diverse areas during the period - 19.7 percent and 20.1 percent, respectively.

The disparities were more marked when the researchers compared Black residents of the most segregated neighborhoods and their White counterparts in the least segregated areas. In that case, Black candidates had 59 percent lower access to kidney transplants than the White patients.

The type of segregation affected the numbers, too: Black candidates registered at kidney transplantation centers in predominantly minority neighborhoods had 64 percent lower access than their White counterparts in majority-White neighborhoods.

Underinvestment in segregated neighborhoods and institutional and structural factors may play roles in the disparities, the researchers suggest. They call for better community outreach and more diverse leadership at kidney transplant centers. But overall, they write, it will take “interventions to reduce social inequity at the structural level” to level the field for everyone in need of a transplant.