A new national study evaluating a landmark U.S. transplant policy change finds that efforts to correct the harms of race-based kidney function equations are associated with increased kidney transplantation rates among Black patients. The study, published in JAMA Internal Medicine, underscores how reparative strategies that address the harms of race-based algorithms in medicine can help save lives.
Previous national clinical guidelines recommended using race-based equations to estimate kidney function, which assigned higher kidney function estimates to Black patients. These equations contributed to Black patients experiencing delays in both referral to kidney specialists and placement on transplant waitlists.
In 2021, national guidelines were changed to ban the use of race-inclusive kidney function equations for purposes of transplant listing. Then, in December 2023, the Organ Procurement and Transplantation Network (OPTN) announced a policy requiring that all U.S. kidney transplant programs submit wait time modifications for Black candidates who were disadvantaged by prior use of a race-based equation.
A collaborative team, led by researchers at Beth Israel Deaconess Medical Center, Brigham and Women's Hospital, and Boston Medical Center, analyzed a database of all U.S. kidney transplants performed between January 2022 and June 2025 to compare transplant rates by race and dialysis status before and after the OPTN policy change.
The study found that over 21,000 candidates received wait time modifications, resulting in an average gain of 1.7 years, increasing their priority status on the waitlist. Among Black candidates, the policy change was associated with an increase of 5.3 transplants per 1,000 listings. In additional analyses, the updated policy was linked to increased transplant rates among Black patients who were listed for transplant both before and after dialysis initiation.
"Our findings indicate that reparative approaches to address the harms caused by race-based clinical algorithms can help move the needle toward health equity," said Rohan Khazanchi, MD, MPH, a resident in combined internal medicine and pediatrics at Brigham and Women's Hospital and Boston Medical Center. "Black patients and other marginalized groups are still not transplanted equitably despite being diagnosed with end-stage kidney disease at much higher rates, so there remains a continued need for accountability and intervention to ensure that all communities are equitably prioritized."
The researchers emphasize that while the results are encouraging, further work is needed to understand longer-term outcomes and to address variation in how consistently wait time modifications have been used across transplant centers. Given the narrow focus of this OPTN policy on remedying the harms of race-based kidney function equations, additional interventions are also needed to support patients who face other barriers to early nephrology care and transplant evaluation.
"This study provides important evidence that guideline and policy changes can translate into real clinical impact for patients," said Martha Pavlakis, MD, the paper's senior author and the Program Director of Solid Organ Transplantation at Beth Israel Deaconess Medical Center. "Correcting wait time inequities has meaningful implications for transplant access, and it reinforces the importance of aligning clinical practice and policy with principles of fairness and evidence-based care."
