http://www.renalbusiness.com/news/2011/10/new-policy-reduces-racial-disparity-in-transplantation.aspx
NEW POLICY REDUCES RACIAL DISPARITY IN TRANSPLANTATION
A change in the kidney allocation policy dramatically reduced the racial disparity between the rates at which African Americans and whites receive deceased donor kidney transplants (DDKT), according to a study published in the November issue of the American Journal of Kidney Diseases.
In 2003, the United Network for Organ Sharing (UNOS) reversed a policy which assigned priority to potential kidney recipients who genetically matched up with the deceased donor in terms of HLA-B, an antigen found on the surface of cells that is involved in the immune response to foreign tissue and tends to be racially clustered. The preference given HLA-B matches, combined with a higher percentage of white donors, resulted in almost inevitable racial disparity in DDKT recipients.
Researchers from the Johns Hopkins School of Medicine led by Dr. Erin Hall studied the consequences of the policy change on the racial inequality for a DDKT by examining the length of time 178,902 patients waited from initially being placed on the kidney transplant waiting list to the actual transplant. They found that before the policy change, African Americans were 37 percent less likely to receive a DDKT than their white counterparts; and after the change in policy, African Americans were only 23 percent less likely to receive a DDKT than whites.
According to Dr. Dorry Segev, the study's senior author, the policy change has not affected the transplant success rate. "With today's anti-rejection medications, it is likely that HLA matching is less relevant than in the past, but probably not completely irrelevant."
Although the new policy dramatically reduced the inequality between African Americans and whites receiving a DDKT, a sizable disparity still remains. "While HLA-B matching was a disparity that resulted specifically from the allocation system, it is likely that the residual causes are at the patient and provider levels," said Segev.
"For example, a patient may be reluctant to accept certain organ offers, or there may be geographic disparities involved. Another possibility is the conventional thinking that African Americans do better on dialysis than Caucasians. If a patient or his physician feels that he will do just fine on dialysis, he will be more reluctant to accept the up-front risk of the transplant. Studies have found that while this is true in older patients, it is actually the opposite in younger ones. Younger African Americans do far worse on dialysis than their Caucasian counterparts."