Winston: One of the leading causes of death in America, Kidney disease It is a serious public health problem. The disease is particularly severe in Black Americans, who are three times more likely to experience kidney failure than white Americans. While Black people make up only 12 percent of the U.S. population, they make up 35 percent of people with kidney failure. This is partly because of the prevalence of diabetes and high blood pressure — the two biggest causes of kidney disease — in the Black community.

There are nearly 100,000 people in the U.S. waiting for a kidney transplant. Although Black Americans are more likely to need a transplant, they are also less likely to receive one.

Making matters worse, kidney Black donors Kidneys from all-Black donors are more likely to be discarded as a result of a flawed system in the U.S. that erroneously assumes that kidneys from all-Black donors are more likely to fail after transplant than kidneys from donors of other races.

As a scholar of bioethics, health, and philosophy, I believe this flawed system raises serious questions ethical concerns About justice, fairness and good management of a scarce resource – the kidney.

How did we get here?

America Organ transplant The system determines the rating of a donor kidney using the Kidney Donor Profile Index. The index is an algorithm that takes into account 10 factors, including the donor’s age, height, weight, and history of hypertension and diabetes.

Another factor in the algorithm is caste.

Research on past transplants shows that some kidneys donated by Black people stop working sooner after transplant than kidneys donated by people of other races.

This reduces the average survival time for a patient receiving a kidney from a black donor.

As a result, kidneys donated by people of color are wasted at a higher rate, because the algorithm downgrades their quality based on the donor’s race.

This means that some good kidneys may be wasted, raising a number of ethical and practical concerns.

Risk, race, and genetics

Scientists have shown that races are social constructs that are poor indicators of human race. genetic diversity,

Using the donor’s race assumes that people who belong to the same socially constructed group share important biological characteristics, whereas there is evidence that there is more genetic variation within racial groups than between other racial groups. This is also the case for black Americans.

It is possible that the observed differences in outcomes may be explained by genetics rather than race.

people who have two copies of some forms or types of the drug APOL1 gene They are more likely to develop kidney disease.

About 85 percent of people with these variants never develop kidney disease, but 15 percent do. Medical researchers don’t yet understand what’s behind this difference, but genetics is probably only part of the story. The environment and exposure to certain viruses are also possible causes.

Nearly all of the people who have two copies of the risky variants of the APOL1 gene have ancestors who came from Africa, particularly western and sub-Saharan Africa. In the U.S., these people are usually classified as black or African American.

Research on kidney transplants shows that kidneys from donors with two copies of the high-risk APOL1 variant fail at a higher rate after transplant. This may explain the statistics on black donor kidney failure rates.

How might this practice change?

Healthcare professionals decide how to use and distribute limited resources. With this comes an ethical responsibility to manage resources appropriately and wisely, including preventing unnecessary loss of transplanted kidneys.

Reducing the number of kidneys that are destroyed is important for another reason.

Many people agree to donate organs to help others. Black donors may be troubled to learn that their kidneys are more likely to be destroyed because they came from a Black person.

This practice may further erode trust in Black Americans health care system Who has a long history of mistreating black people.

Making organ transplants more equitable may be as simple as ignoring race when evaluating donor kidneys, as some medical researchers have proposed.

But this approach would not take into account the differences seen in transplant outcomes and could result in some kidneys being transplanted that have a higher risk of early failure because of a genetic problem.

And since black kidney recipients are more likely to receive kidneys from black donors, this approach may perpetuate transplant disparities.

Another option that would improve public health and reduce racial health disparities is to identify the factors that cause some kidneys donated by Black people to fail at higher rates.

One way researchers are working to identify high-risk kidneys is through the Apollo study, which assesses the impact of major variants on donated kidneys.

In my view, using variants rather than strains would likely reduce the number of kidneys that are wasted, as well as protecting recipients from kidneys that stop working soon after transplant. (The Conversation) NPK NPK