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End-stage renal disease is three times more common in Black people, yet Blacks are significantly less likely than whites to be given a kidney or be put on the transplant waiting list.
A Black man waiting for a kidney for more than five years has filed a lawsuit alleging racial bias in the method used to prioritize patients needing organ donations in the U.S.
Anthony Randall is a Los Angeles barber who undergoes dialysis three times a week and cannot work due to kidney disease. On Wednesday, according to The Washington Post, he filed the suit against a subsidiary of the Los Angeles hospital Cedars-Sinai, where he is a transplant patient, and the United Network for Organ Sharing nonprofit, operators of the nation’s organ transplant system.
UNOS and Cedars-Sinai no longer use the problematic portion of the algorithm cited in Randall’s complaint. In June, the transplant system’s board of directors found that including a “modifier for patients identified as Black” had resulted in a widespread underestimation of the severity of kidney disease for many Black patients.
“Specifically in organ transplantation,” the board of directors said, according to The Post, “it may have negatively affected the timing of transplant listing or the date at which candidates qualify to begin waiting time for a transplant.”
In January, UNOS gave hospitals the go-ahead to stop using that algorithmic component and let Black kidney transplant candidates know they might be eligible for adjustments to their “accrued wait time,” a crucial factor in determining the order of potential kidney recipients because kidneys are in short supply. Randall claims that if someone had made those changes sooner, he could have been eligible for the kidney he needs.
“The above-described racial discrimination damaged [the] plaintiff and members of the nationwide waitlist class, the California waitlist class, and the Cedars-Sinai class,” the suit contends, The Post reported, “by depriving and/or delaying their award of a donor kidney.”
Randall’s lawsuit is the most recent attempt to contest the principles and operations of the nation’s ailing organ transplant system. Last month, the government made plans to restructure the transplant system, including ending the monopoly UNOS has held over its management since 1986.
In August, a Senate committee looking into systemic issues for three years released a damning report that blamed UNOS and the organizations that collect organs nationwide for the 70 unnecessary deaths and 249 illnesses caused by errors in organ screening for transplant organs.
There are 104,000 people still on the transplant recipients waiting list, most needing kidneys. According to the calculations, 17 to 33 patients a day die while awaiting kidneys, livers, lungs, hearts and other organs.
“He’s had this ongoing delay in the process of getting a kidney,” said Randall’s attorney, Matthew L. Venezia, The Post reported. “[Cedars-Sinai] could have adjusted his wait time. They just didn’t. A lot of these patients don’t have another 18 months.”
There is a consensus that the system is racially biased. While end-stage renal disease is three times more common in Blacks than whites, Black people are significantly less likely to be given a kidney or be put on the transplant waiting list.
Last year, the National Academies of Sciences, Engineering and Medicine referenced research that showed Blacks linger a median of 727 days for kidneys after being put on the waiting list, while whites wait 374 days. In addition, Black patients are 37 percent less likely to be referred for transplant evaluation before needing dialysis than their white counterparts.
Randall’s lawsuit also addresses the formula used to choose which patients get to go first for kidney transplants when they become available, taking into account cumulative time spent on the waitlist. According to his lawsuit, being on the list partially depends on not meeting a cutoff point that denotes poor kidney function.
He claims the formula has long disadvantaged him and other Black people. According to the lawsuit, Randall’s “wait time continues to be incorrectly calculated in UNOS’s UNet software, prejudicing [the] plaintiff’s candidacy for a donor kidney from the national kidney wait list” as of Wednesday, when he filed the suit.
Randall is requesting more than $5 million for himself and other Black people on the kidney transplant waiting list, plus the urgent recalculation of his wait time. He also wants permission from a federal court to represent 27,500 Black U.S. patients who, in his opinion, have suffered similar disadvantages.
UNOS spokeswoman Anne Paschke said the organization would handle the matter in court.
Cedars-Sinai stated that while it could not speak about specific patients, it “continues to be committed to the health and well-being of everyone under our care” as an institution founded on diversity, equity and inclusion principles.
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