April is Minority Health Month, a month to raise awareness about the need to reduce health disparities and improve the health of minority communities. The UNC Health Center for Transplant Care team and UNC Health nephrologists recently increased equitable access for the Black community by addressing and fixing a disparity among kidney transplant patients.
The UNC Health Center for Transplant Care team at the UNC Medical Center recently collaborated with UNC Health nephrologists to ensure Black patients received equitable access to kidney transplants.
Before the policy was implemented, the estimated Glomerular Filtration Rate (eGFR) – a tool used by kidney transplant programs to measure a patient’s kidney function – included a race-based coefficient, which consistently assigned a higher eGFR to patients who identify as Black or African American. Patients who have an eGFR of 20 or below are eligible for a kidney transplant, but this race coefficient systematically resulted in a higher eGFR for Black patients, potentially delaying referrals for transplant on the transplant waiting list.
“Black patients had to reach a higher creatinine level than white patients to be put on the kidney transplant waitlist, experienced delayed referral to nephrologists, and several other consequences,” said Keisha Gibson, MD, MPH, associate professor of medicine and pediatrics, chief of pediatric nephrology in the Division of Nephrology and Hypertension at the UNC School of Medicine. “The observational studies that supported this notion that Black patients have higher creatinine levels than white patients were heavily flawed, biased, and non-generalizable.”
As recommended by the National Kidney Foundation and the American Society of Nephrology Task Force, UNC Health transitioned to the new formula without the race coefficient for calculating eGFR in the summer of 2022 for all patients moving forward.
However, in January 2023, the United Network for Organ Sharing (UNOS) required transplant centers across the country to review past records for Black patients and identify when the threshold eGFR of 20 or below would have been reached for each patient if the race variable had not been applied. They needed to finish this project by January 2024. This created a problem for the UNC Hospitals Transplant team: there were hundreds of patients’ information in the UNC Health system that needed to be reviewed, and the team needed additional resources to ensure they met this goal in time.
With support from Audrea Caesar, PhD, SHRM-SCP, CHES, chief equity & inclusion officer at UNC Health and UNC School of Medicine, the transplant team’s “Breaking Down Barriers to Kidney Transplant Committee led by Katie Westreich, MD, assistant professor of medicine and pediatrics and pediatric nephrologist, was able to hire a full-time temporary employee to assist them with the project.
“We started with communications,” said Valerie Kulkarni, the temporary employee who was hired to assist with the project. “The communications went out to all UNC Health kidney transplant patients. After that, we started looking into different lab results that were drawn through EPIC and external diagnostic centers.”
“It was a huge project, and we’re so grateful we were able hire someone temporarily to do this work,” said Emily Arnold, MSN, RN, CNN, assistant director of transplant services at UNC Hospitals and program manager for this project. “If we didn’t have the additional staff, we would have been more rushed to get it done, but I feel confident that Valerie had the time to really dig through these records.”
Because of this work, the UNC Hospitals Transplant team finished the project in October 2023 – four months before the deadline. In addition, of the 464 patients reviewed on UNC’s transplant waiting list, 309 qualified for and received additional waiting time credit, meaning they were eligible to get kidney transplants sooner. As a result of this, 45 Black patients at UNC Health received a transplant since October 2023 and thousands more across the country have or get to receive kidney transplants sooner.
“It’s a major step in the right direction on a national level,” Arnold said. “This is just one step of many that are being taken and hopefully will be taken to help Black patients.”
However, there is still a long way to go in addressing health disparities among minority communities.
“We have to understand that we all inherently have biases (it’s part of what makes us human) and we have to do the work to understand what they are and where we may have blind spots,” said Gibson. “We all have to recognize that our roles as medical professionals automatically designate us as leaders in the community and thus, we cannot turn a blind eye to the many things that impact patient care like inequitable access to transportation, high-quality food, high quality education, and mental healthcare to name a few.”
Media Contact: Brittany Phillips, Communications Specialist UNC Health | UNC School of Medicine