Physician bias might keep life-saving transplants from black and Hispanic patients

Nov 09, 2009

Physician bias might be the reason why African Americans are not receiving kidney/pancreas transplants at the same rate as similar patients in other racial groups. Dr. Keith Melancon, director of kidney and pancreas transplantation at Georgetown University Hospital and associate professor of surgery at Georgetown University Medical Center, and colleagues explore this phenomenon in the November issue of the American Journal of Transplantation.

Medicare coverage for people needing a simultaneous kidney/pancreas transplant has increased in the past decade. In July 1999 Medicare made the changes as a conscious effort by the government intended to address racial and economic disparities that existed. But increased Medicare dollars have not translated into more access for African Americans or Hispanics.

"Our research raised the possibility of racial bias on the part of physicians who might incorrectly assume that African Americans are type 2 diabetics when in fact, they would metabolically meet the criteria for type 1 diabetes," said Dr. Melancon. "Since this is a transplant that is most often performed in type 1 diabetics, their doctors might not even raise the possibility with their black patients. Also, health care providers might incorrectly predict worse outcomes for black patients, despite research that shows they do about as well as other racial groups."

Dr. Melancon's group took a look at the national transplant list before and after the Medicare changes in July 1999. Of the patients already listed for transplant, African Americans were 27% less likely to be recommended for a kidney pancreas transplant than Caucasians. Hispanics were 25% less likely to be recommended. After the Medicare changes African Americans were 28% less likely to be recommended for kidney/pancreas transplant and Hispanics were 31% less likely to be recommended.

"So, the situation for African Americans and Hispanics actually got worse instead of better," said Dr. Melancon.

The benefits of a kidney pancreas transplant are the list is much shorter; 2200 compared with over 80,000 for a kidney alone, according to the United Network of Organ Sharing (www.unos.org). Patient survival and kidney graft survival are better in kidney pancreas transplants.

"I don't think the medical community has been aggressive enough about kidney/pancreas transplant, especially in African Americans who are assumed to have type 2 diabetes. When a person has type 2 diabetes and they are obese, the benefit of a kidney/pancreas transplant is often outweighed by the risks of surgery which are higher in an obese person. So they are not offered the transplant. There is also a population of people with diabetes who are sort of between type 1 and type 2. This procedure would work for them too. But I think the medical community is, in some cases, making assumptions about the African American and Hispanic population that they are not making with other racial groups."

A kidney/pancreas is the only current, reliable way to give diabetics normal glucose and insulin levels 24 hours a day. It's not technically a cure, but it does eliminate the medical problems associated with diabetes.

Source: Georgetown University Medical Center (news : web)

Explore further: ALS Ice Bucket Challenge arrives in North Korea

add to favorites email to friend print save as pdf

Related Stories

Extreme obesity affects chances of kidney transplantation

Jan 10, 2008

For patients on the waiting list for a kidney transplant, severe and morbid obesity are associated with a lower chance of receiving an organ, reports a study in the February Journal of the American Society of Nephrology.

Recommended for you

ALS Ice Bucket Challenge arrives in North Korea

Aug 31, 2014

It's pretty hard to find a novel way to do the ALS Ice Bucket Challenge by now, but two-time Grammy-winning rapper Pras Michel, a founding member of the Fugees, has done it—getting his dousing in the center ...

Cold cash just keeps washing in from ALS challenge

Aug 28, 2014

In the couple of hours it took an official from the ALS Association to return a reporter's call for comment, the group's ubiquitous "ice bucket challenge" had brought in a few million more dollars.

Medtronic spends $350M on another European deal

Aug 27, 2014

U.S. medical device maker Medtronic is building stronger ties to Europe, a couple months after announcing a $42.9 billion acquisition that involves moving its main executive offices across the Atlantic, where it can get a ...

User comments : 1

Adjust slider to filter visible comments by rank

Display comments: newest first

Birthmark
not rated yet Nov 09, 2009
Bias, racism, prejudice, discrimination...this does us good how?