HMS study finds racial gap in kidney transplants

Black people are much less likely than white people to be referred for kidney transplants, a new Harvard Medical School (HMS) study has found.

The study, one of many recent efforts to investigate the racial health care gap, found that white people with kidney failure were about 4 percent more likely to want a transplant than are black people. But black people were more than 20 percent less likely to be referred for evaluation and placement on a transplant wait-list.

The study also found that many doctors failed to inform black patients about the possibility of receiving a kidney from a family member instead of going on a wait-list.

One of the study's authors said poor doctor-patient communication is probably largely to blame for the discrepancy.

White doctors are more able to communicate with patients who are "closer to them culturally," said Dr. John Z. Ayanian, assistant professor of medicine and health care policy at HMS.

"We need to encourage physicians and patients to have more thorough discussions," he said.

Health Care Financing Administration (HCFA) officials announced last week that they will step up enforcement of existing rules against racial bias in kidney transplants.

HCFA, the federal agency that runs Medicare, Medicaid and various children's health programs, covers most dialysis and transplant costs for patients of all ages who lack private insurance.

It pays for 80 percent of dialysis costs, which are about $48,000 a year. It generally funds more than that proportion of transplant costs, which average $92,000.

For about a decade, studies have found racial discrepancies in the treatment of kidney failure, heart disease, arthritis, cancer and other life-threatening illnesses.

The HMS study found that several of the reasons usually offered for the racial gap do not account for the difference. Three common theories are that more black patients do not want transplants, that fewer black patients have private health insurance and that more black patients have fatal diseases that make transplants unnecessary.

However, the HMS study found that three-fifths of the racial gap remained after taking all of those factors into account.

Ayanian, who also works at Brigham and Women's Hospital, said he believes results would be similar for other conditions such as heart disease.

The HMS researchers looked at kidney transplants in part because the HCFA's program makes money less of an issue for patients who do not have their own insurance, Ayanian said.

The study was published Nov. 25 in the New England Journal of Medicine.

In the same issue of the journal, Johns Hopkins School of Medicine researchers published a study on kidney transplants that found that patients at for-profit dialysis centers are less likely to get on transplant wait-lists than those at not-for-profit centers.

They mainly faulted understaffing. But they also said that for-profit centers might not want to lose patients who get transplants.

The HMS researchers conducted telephone interviews with about 1400 patients from Alabama, California, Michigan, Maryland, Virginia and Washington D.C. All of the patients had been on dialysis at least 10 months.

Ayanian is currently working on a survey of the physicians who cared for the patients in this study.