Black people in the United States are disproportionately affected by kidney disease, being three times more likely to develop kidney failure than white Americans. Despite the high prevalence of disease, out of the estimated 89,000 people currently on the waitlist for a new kidney, only about 30 percent are Black. Systemic barriers, such as race-based testing formulas, socioeconomic disparities, and lower rates of living donor transplantation, have kept the number of Black kidney transplant recipients low.
However, the latest research highlights that healthcare professionals are now working to address the health inequities Black patients face — and the results so far are promising.
A new study published in JAMA Internal Medicine found that a national policy designed to fix race-based bias in kidney care was associated with higher kidney transplant rates among Black patients.
Researchers assessed a 2023 Organ Procurement and Transplantation Network (OPTN) policy that required transplant centers to adjust waiting times for Black kidney transplant candidates harmed by older race-based kidney function formulas.
The study’s findings are one step towards addressing disparities in kidney transplants and improving outcomes for the Black community.
For many years, kidney function was measured using equations that included race as a factor. It was believed that Black patients had a higher muscle mass, so the formulas often assigned them higher kidney function scores than non-Black patients with identical lab results.
This meant that Black patients could seem healthier on paper, even though their kidney disease was progressing.
Ultimately, many Black patients experienced delays in:
Many medical and public health professionals argued that these race-based equations lacked biological justification and reinforced structural inequities rather than improving accuracy.
In 2021, this clinical standard was removed to ensure equitable diagnosis and avoid delayed treatment. The National Kidney Foundation and American Society of Nephrology Task Force recommended the immediate implementation of new equations and the use of cystatin C in all U.S. laboratories.
Later in 2023, OPTN took it a step further by requiring all transplant programs to review Black candidates and retroactively restore lost waitlist time when race-based equations had delayed eligibility.
In the study, researchers reviewed national data from the OPTN from January 2022 through June 2025, which included:
A quasi-experimental interrupted time series was used to compare transplant rates before and after the 2023 policy implementation.
Researchers analyzed the following:
Using this study design can help determine whether the policy itself was associated with measurable changes in kidney transplant waiting times for Black patients.
Between January 2023 and June 2025:
This is a significant correction of previously lost access.
After policy implementation, Black patients experienced 5.3 additional transplants per 1,000 listings. This was statistically significant, suggesting that the policy helped eligible patients receive transplants much faster.
Researchers found improved transplant rates across preemptive candidates (those not yet on dialysis) and postdialysis candidates.
This is important because earlier transplant often leads to better outcomes than waiting until dialysis is required.
Outside of Black patients, the study found no significant changes among non-Black or Hispanic candidates. This finding suggests that the gains for Black patients did not negatively affect other groups.
It is important to note that the rise in transplant rates for Black patients was primarily linked to deceased donor kidney transplants, not living donor transplants. While policy changes can improve access, living donor disparities may require another solution.
This research provides rare insights into how addressing long-standing structural racism in the healthcare system can produce measurable clinical benefits.
Too often, disparities are discussed, but not addressed. In this study, researchers found that directly addressing a known policy harm was associated with better transplant access for Black patients.
This evidence is significant for Black communities, as their risk of kidney disease remains high due to a multitude of factors, including:
The study challenges the assumption that race-based algorithms are harmless or scientifically neutral. When biased systems are corrected, outcomes can improve.
A national policy designed to remove race-based kidney equations was linked to increased kidney transplant rates for Black patients. That substantial finding makes this study much more than a policy story — it’s proof that healthcare systems can move beyond acknowledging inequities and begin reversing them.
For Black patients waiting on life-saving kidney treatment, that shift can mean years regained — and lives saved.
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