Methodist leads the way in North Texas to bring equality to kidney transplants

In the United States, more than 37 million adults have kidney diseases with a disproportionate number of those people being minorities, like Black and Hispanic. In many areas of healthcare, such as kidney transplantation, these groups face barriers and inequities in care.

Over the last few years, more and more questions were raised about the use of a race coefficient or ‘race modifier’ in one of the kidney function measurement tools used by transplant hospitals to qualify people for kidney transplants.

Basic information

Transplant hospitals use a formula called Estimated Glomerular Filtration Rate (eGFR) to determine how well a patient’s kidneys are functioning.

Kidney transplant candidates’ eGFR values are used as qualifying criteria for kidney transplants (you qualify if your eGFR is below a certain threshold).

Some hospitals use formulas that include a Black race coefficient, which can overestimate eGFR values for Black patients and lead to delayed treatment/delayed qualification for kidney transplants (studies have shown that Black patients have higher creatinine levels so the coefficient is meant to adjust for these differences)

Currently, UNOS policy allows hospitals to use equations that both include and exclude the race coefficient, which means UNOS does not dictate what formula to use.

In August 2021, UNOS set out a proposal to require hospitals to only use race neutral eGFR calculators which would bridge the gap in race inequities in transplants for Black candidates.

Source:United Network for Organ Sharing

Methodist takes action

Soon after the UNOS policy change proposal, Lori Kautzman, MD, hepatobiliary and abdominal transplant surgeon on the medical staff at Methodist Transplant Specialists, used her knowledge and experience as a member of the American Society of Transplant Surgeons Diversity, Equity and Inclusion Committee to lead a discussion at Methodist about eliminating the use of a race variable in the eGFR.

“I am passionate about bringing equality to healthcare, especially access to transplants, so it was an honor to lead this discussion,” says Dr. Kautzman. “As a group, we decided that we wanted our transplant program to set an example and be at the forefront of this movement.”

As of August 2021, Methodist Transplant Specialists became the first transplant program in the area to formally adopt a policy to eliminate the use of any formulas that use the Black race variable in eGFR calculations.

“This is a big step towards healthcare equality for the transplant community,” says Dr. Kautzman. “We are excited for the future improvements that are going to take root once this policy becomes standardized across all transplant programs.”