 Students at the Rosemary Anderson/Portland Opportunities Industrialization Center enjoy a health leadership training session that includes healthy eating options, offered by the Portland Multicultural Integrated Kidney Education Program this week. Helen Silvis photos |
At every transplant center in the nation, African Americans are the least likely to receive a kidney from a living organ donor.
Research published in the American Journal of Kidney Diseases, the official journal of the National Kidney Foundation, used data gathered from all 275 transplant centers in the U.S., and showed that those facilities serving predominantly African American populations had even higher rates of living donor transplant disparities.
"We were quite disappointed to find that not a single center in this country had equal attainment of live donor kidney transplants in African Americans and non-African Americans," said the study's lead author, Dorry Segev, MD, of Johns Hopkins University School of Medicine.
"We were hoping to find at least a few centers where there as racial parity, so we could learn best practices," Segev said. "We were surprised to find that those centers that treated the highest percentage of African Americans actually had the highest racial disparities."
In Portland, the Multicultural Integrated Kidney Education Program is working to get ahead of the statistics through health leadership classes for youth. M.I.K.E. President Cheryl Neal says prevention is the best way to save lives from kidney failure.
"African Americans are, roughly and proportionately, about four times more likely to be treated for kidney failure," she said. "About 70 to 80 percent of kidney failure is preventable by eating well, staying fit with physical activity, avoiding salt, drinking water – simple things we know can improve our health in general."
Studies show that living kidneys – donated by a compatible individual – last longer and are generally healthier than kidneys taken from a deceased donor.
The Johns Hopkins study showed that at transplant centers with the highest disparities on living organ donation, African Americans had 76 percent lower odds of obtaining a kidney from a living donor. Even at the facilities that came closest to equality, African Americans were still 35 percent less likely to obtain a transplant.
There are more than 92,000 people waiting for a kidney in the United States, and over a third of those are African Americans. In 2011, there were 5,771 living donor transplants performed -- the lowest rate in ten years -- but only 813 of those kidneys were received by African Americans.
Neal says kidney failure is at an epidemic level in part because it is linked to the obesity epidemic. And the problem is made worse by the high cost of kidney dialysis and transplantation – the only ways for kidney patients to avoid organ failure.
It costs close to $35,000 a year for the typical person on dialysis to obtain medical care, she said, and a transplant can cost as much as $250,000.
"There are a lot of social justice issues in health," Neal says. "It is a tragedy to lose people to issues that don't have to affect them, it's also enormously expensive."
Dr. Segev agreed that the disparities could be explained, at least in part, by the epidemics of obesity, hypertension and diabetes, which are likely ruling out many potential African Americans organ donors from giving to a friend or family member. Differences in culture, education and social attitudes as well as barriers to medical care in general may also be factors.
"We need to figure out the keys to successfully reducing disparities," Dr. Segev said. "What is it that centers do to help their patients identify living donors? How do they get live donors evaluated efficiently? And how do their patients address the many barriers to successful live donor transplantation, particularly those faced by African Americans?"
The staff of M.I.K.E., which is based at Providence St. Vincent Hospital, travels throughout the area teaching young people how to educate their families and communities on better kidney health through diet and exercise.
"The M.I.K.E. program recruits community mentors who will work with young people on a weekly basis to guide them through a curriculum, and we prepare people to be ambassadors for health," she said. "The whole idea is to start a ripple effect through education and mentorship and community outreach."
"The National Kidney Foundation's END THE WAIT initiative is focused on reducing the wait for transplant for everyone on the waiting list," said Joseph Vassalotti, MD, the National Kidney Foundation's chief medical officer.
"First, we must make an effort to increase living donation for everyone who is eligible for kidney transplantation," he said. "Second, we have to explore different ways to reduce racial disparities in access to living donor kidney transplantation.
"Third, we need to find ways that amplify collaborative interactions between patients and transplant centers to find potential living donors," Vassalotti said. "And finally, we have to address why there is such variation between transplant centers in the U.S."
The MIKE Program holds its annual benefit dinner and auction Sept. 14 at the Multnomah Athletic Club. Find out more about their work at www.mikeprogram.org.
Read more about the National Kidney Foundation at www.kidney.org .
