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Kidney Transplants Are More Equal Opportunity

Rules changed to help minority patients

WEDNESDAY, Feb 4, 2004 (HealthDayNews) -- Rules regulating kidney transplants have been changed to correct what was seen as an ethnic imbalance in who gets the limited number of donated organs, says the organization that sets national transplant policy.

The strict rules that steered kidneys to patients who most closely matched the immunological type of the donated organ have been relaxed so that more kidneys go to blacks and Hispanics, says Joel Newman, director of communications at the United Network for Organ Sharing.

The matching system centers on the HLA antigen molecules that can alert the immune system to the presence of foreign tissue, triggering an attack that can lead to rejection of the transplant.

"The concern was that although there was value in HLA matching, some of the antigens used tended to be more specific to donor populations," Newman says. "Most donors are Caucasian, while many people awaiting transplants are black or Hispanic."

More than a third of the 56,500 Americans awaiting transplants are black, and another 15 percent are Hispanic, Newman says. Only about 9,000 kidney transplants will be done this year.

The change in policy started when "a set of issues was raised by a number of different organizations" about the fairness of the old kidney allocation system, Newman says. Those concerns led to a study by experts at the University Renal Research and Education Association (URREA) on the possible effects of a change.

That study, published in the Feb. 5 issue of the New England Journal of Medicine, concluded that changing the allocation system "could reduce the existing racial imbalance by increasing the number of transplantations among nonwhites, with only a small increase in the rate of graft loss."

Early results indicate the rule change is doing what it was intended to do, says study author Dr. Friedrich K. Port, professor emeritus of medicine and epidemiology at the University of Michigan and president of URREA.

"There has been a shift of 7.2 percent in kidney transplants toward minority patients," Port says. "That is right on target with the information we had."

The record of the first four months of the new rules indicate the results are "remarkably close to the assessment made in the study," he says.

It is too early to tell what the results of the change have been, he says. "We're still collecting information," Newman says. "In about six months, we should have enough data for an analysis."

The study looked at more than 70,000 people who were on the waiting list for kidney transplants from 1994 to 1997, matching their antigen profiles with those of donated organs.

It concluded that changing the rules would decrease the number of transplants among whites by 4 percent -- 166 fewer transplants a year -- while increasing transplants for blacks by 6.3 percent. Transplant rejections would increase by only 2 percent.

"We agree that the change confers benefits to the minority population while not taking too much access away from other groups," Newman says.

More information

The basics of kidney transplantation can be found at the National Library of Medicine. Learn about kidney disease from the National Institute of Diabetes and Digestive and Kidney Diseases.

SOURCES: Friedrich K. Port, M.D., professor emeritus, medicine and epidemiology, University of Michigan, and president, University Renal Research and Education Association, Ann Arbor, Mich.; Joel Newman, director, communications, United Network for Organ Sharing, Richmond, Va.; Feb. 5, 2004, New England Journal of Medicine
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