Racial and ethnic disparities in kidney transplantation at a large center in southern California

Kidney transplantation is a lifesaving procedure for patients with end-stage renal disease, but despite over 95,000 people waiting for kidneys on deceased donor waiting lists, only 13,750 received a transplant in 2012, while 3,652 died waiting. Organs from living donors function nearly twice as long as those from deceased donors, but the number of living donors in 2012 was the lowest in over a decade. In the context of this enormous gap between supply and demand, racial disparities in access to transplantation have perniciously remained despite outreach and education efforts aimed at eliminating them. Nationally, non-Hispanic Whites comprised 59.7% of all transplants and 67.5% of living donor transplants in 2012, despite comprising only 37.8% of the waiting list. We used administrative data from 1964-2012 from a large transplant center in one of the largest and most diverse cities in the United States to investigate how the characteristics of living donor transplantation and donation have changed over time, and to provide insight for the future of the nation as it increases in diversity, particularly in the Latino population. We found that dramatic racial and ethnic disparities existed, with non-Hispanic Whites making up a significantly large proportion of recipients receiving a living donor kidney (>60%) while a disproportionately smaller proportion were on the center's deceased donor waiting list (24.2%) when compared to Blacks, Latinos, and Asians, even when considering county population proportions of these groups. In all but two years from 2004 to 2012, the proportion of non-Hispanic Whites was significantly greater than any other race for both recipients and donors, although the proportion of non-Hispanic Whites remained slightly higher for donors than recipients (range 45-55% and 36-57%, respectively) (p<0.05). From these observations, we believe that education and recruitment resources must be focused on racial and ethnic minority recipients – not only Black recipients as has been the case in many interventions previously published – particularly those who are seeking a repeat transplant. Promising strategies published previously by our and other groups include social network education interventions for the friends and families of those seeking transplants and transplant exchanges, which allow incompatible donor-recipient pairs to “swap” kidneys, and thus makes living donations possible where recipients may otherwise have been placed on deceased donor waiting lists.