The goal of this study was to evaluate whether black patients have similar access to the national Organ Procurement and Transplantation Network (OPTN) wait list compared with white patients.

Data for these analyses were derived from two sources: the OPTN wait list data sets and the national registry of end-stage renal disease (ESRD) patients – the HCFA ESRD PMMIS. Three analyses were conducted. First, the percent of ESRD patients who received a transplant (the most direct and the most relevant measure of access) was estimated. Second, access to the OPTN wait list was estimated. Note that this analysis did not adjust for people who might be eligible to be wait listed but were not put on the list because they received a living transplant. For these two analyses, new Medicare ESRD patients 1992 under 55 years of age during the period from 1988 to were included. The third analysis was designed to evaluate time to transplant after placement on the wait list. Living donor transplants were considered censoring events and were therefore accounted for in this analysis. All Medicare patients during these years were included regardless of age.

Overall, the annual rate of renal failure was 81 per million persons. Rates were comparable between Asian-Americans and whites, but Native Americans were twice as likely as whites, and blacks were almost four times as likely as whites to suffer renal failure.

About 16.1% of patients had a transplant within one year of renal failure; 36.7% received a transplant within three years; and 46.1% received a transplant within five years. At one year, white patients were almost four times more likely to have received a transplant than black patients (22.7% versus 6.0%). The rates for Asian-Americans and Native Americans fell in the middle (15.5% and 12.1%, respectively). At five years, whites were still more likely to have received a transplant (56.7%) compared with blacks (30.3%) and Native Americans (38.95%). Asian Americans, however, were slightly more likely than whites to have received a transplant by five years (58.2%). Transplantation rates also varied by cause of renal failure, gender, and age.

Wait listing was most likely to occur within the first year of renal failure, with 25.95% of patients wait listed within one year and 47.2% wait listed within five. Black and Native American patients were the least likely to be wait listed after one year (17.8% and 22.3%, respectively) compared with whites (30.5%) and Asian Americans (37.9%). The pattern was similar at five years.

At the end of five years, 86% of the persons who did not die or leave the wait list for other reasons had received a transplant. Rates varied by gender and diagnostic category, but not by age. White patients were most likely to receive a transplant within one year (51% versus 40.4% for Asian Americans, 37.4% for Native Americans and 34.6% for blacks), but the racial differences narrowed by the end of five years (at least 80% of all racial groups received a transplant by five years).

Over time, the number of new renal failure patients increased, and the rate of transplant decreased. Transplant rate within one year of being placed on the wait list decreased, and decreased differentially across racial groups. The median wait time was 308 days for whites and 439 days for blacks in 1988 and was 384 days for whites and 705 days for blacks by 1992. The change in wait time for Native Americans and Asian Americans was similar to or lower than the change for white patients. The racial patterns held in a multivariate analysis that adjusted for gender, age, and reasons for renal failure.

The authors cite other studies when considering possible reasons for these racial patterns, including biological factors related to matching cadavers with persons on the OPTN and attitudinal factors. They conclude that “the importance of getting on the wait list suggests that measures designed to increase black enrollment on the OPTN (such as education and outreach efforts) should improve access to transplantation for black persons.”