Medical Reparations Have Arrived: Changes designed to increase black patients’ access to kidney transplants pervert good medicine and punish white patients to right nonexistent wrongs.

If racism doesn’t explain the discrepancy, what does? The list of reasons is extensive, reflecting disheartening, stubborn problems that physicians and policymakers have long tried to address. One is the advanced age and complex medical conditions of many black patients with diabetes-related kidney failure; many of these patients are also relatively satisfied with dialysis treatments and unwilling to undergo extensive evaluation for transplant suitability. Others include insufficient health literacy, concern about the surgical procedures associated with transplantation, and lack of a support system for post-operative patients—an especially important factor in transplant suitability. Black families are also less likely to supply kidney donors from relatives.

UNOS and OPTN ignore these facts to advance a race-based agenda. They are forcing transplant centers to rework the waitlist for cadaveric kidneys in such a way that favors black patients. The rationale is that the longstanding formula used to estimate kidney function, which was race-conscious and required a second calculation for black patients, was racist.

Yet this second calculation was necessary to produce an accurate value for kidney function in black patients. Without it, the measure would be highly inaccurate, dramatically underestimating kidney function. (Research shows that people of African-American descent tend to have higher levels of muscle mass compared with other population groups, which can affect the levels of creatinine, a waste product produced by muscles, in their blood. Creatinine is used as a marker to estimate kidney function in GFR equations, including the MDRD equation; however, African Americans may have higher creatinine levels even if their kidney function is normal.)

Validated in multiple studies involving hundreds of patients, the old approach was long criticized yet never shown to be inaccurate. Nonetheless, activists demanded a new formula, officially rolled out in 2021. Less accurate than the previous method, the new one lowers kidney-function assessment for black patients to the point that some who did not qualify for placement on the transplant list now meet the requirement. It is a case study in politicized manipulation of data to achieve a predetermined goal.

OPTN isn’t just using this new assessment going forward. It is retroactively applying the new formula—potentially tracing back decades—to previous assessments of kidney function in black patients. Many black patients previously regarded as ineligible for the transplantation waitlist will now be listed, and some will even be moved ahead of others already on the waiting list. How many patients waiting for years for a transplant will be forced to wait still longer? Some estimates say that roughly 70,000 black patients could potentially benefit. That’s a huge number, considering that the current kidney waiting list stands at about 90,000 patients.