When the news hit this spring that the first genetically modified pig kidney was successfully transplanted into a 62-year-old Black man in Massachusetts, medical and health communities celebrated. It lifted hopes about saving lives amid donation shortages — and opened a door of hope for reducing the health disparities that persist within organ failures and transplants.
Richard “Rick” Slayman died in May, two months after the procedure. There was “no indication” that his death was a result of the transplant, according to a statement by the hospital. He had high blood pressure and type 2 diabetes, which are two of the most common causes of kidney failure.
Still, there’s optimism that such a procedure could combat some of the continued health inequities.
Black Americans are almost four times more likely to suffer from kidney disease compared to white Americans. Because of this, they are overrepresented among dialysis patients. They make up more than 35% of patients, despite making up only about 14% of the U.S. population. For some patients with kidney failure, an organ transplant can be an ideal treatment, but shortages and barriers to access can limit options for Black folks.
One of the biggest debates about reducing health disparities has been the use of eGFR measurements to determine kidney function. It’s a formula that offers health care providers an indication of the health of a patient’s kidneys. But within the algorithm are equations that set a higher bar for Black patients, which can effectively drop them in organ transplant lists or prevent them from other interventions that could save their lives.
With that equation, “we actually have to be sicker to be diagnosed with the same illness as others,” said Dr. Naomi Nkinsi, who’s a family medicine residency physician in Washington state. She was among the medical students who fought during the height of the COVID-19 pandemic and racial justice protests to get the race correction removed.
Before receiving the transplant earlier this year, Slayman underwent a human kidney transplant but started to show signs of failure after a handful of years. That sent him back into dialysis treatment and recurring hospital visits to manage complications from his end-stage kidney failure.
Still, his story marks a significant development in xenotransplantation, which is the act of transplanting organs from one species to another. Here’s more about what this means for the future of health disparities for Black Americans:
What is the latest in terms of how health organizations are using the eGFR? Are most moving away from it?
Yes, many hospitals, medical groups and professional health organizations have already stopped incorporating race into their kidney function calculations. It’s been a long evolution, said Dr. Adrian Baudy, a kidney specialist in New Orleans. He remembers being a medical school student wondering why a patient’s race affected the algorithm’s output. “The answer was always, ‘This is what the studies show,’” Baudy said. “We’ve assumed for a really long time that African Americans had more muscle mass.”
This has a wide range of health implications, from diagnosis to a place on transplant lists and early health-related release from prison, Nkinsi said. Kidney function can also determine which medications are safe and unsafe for patients who are navigating other conditions.
When Nkinsi first learned about the potential consequences of using race in the equation, it got her blood boiling. She wondered why it seemed as though scientific accuracy wasn’t upheld to the same standard for Black patients. In school, she worried about retaliation and her career being at risk for speaking up. Hate mail was flooding in from Twitter, now X.
“It was an absolute fight,” she said. But now, “It’s one area where we’re seeing a distinctive step forward.”
What does the latest development of using genetically modified pig kidneys for transplants mean for Black patients? Could this save lives?
In the world of nephrology, or the study of kidneys, the idea of using organs from other species is not necessarily new, Baudy said. About a decade ago, various scientists began digging into the prospect of expanding into this world and, at that point, they thought this might come to fruition in 20 years. The progress has been rapid, he said. “We are in the future a little bit sooner than we anticipated.”
The progress is a significant step forward in expanding the number of organs available to those who are on wait lists. Because doctors want to match patients with donors that are most likely to be compatible, the wait can be long. On average, it’s about five years, Baudy said.
But with new means of transplantation, he’s optimistic that using other animal organs could knock down the wait to a year or two, or have some patients get transplants before needing dialysis. It could also open up the pool for older, sicker patients who may not be candidates for kidney transplants under traditional circumstances.
What it means is that more people who otherwise couldn’t get timely access may now benefit, he said. Nkinsi still worries about equity in access but is hopeful that the change in eGFR will trickle into transplants as well, meaning more Black patients will be eligible for the lifesaving procedure.
What’s the most urgent next step in terms of improving kidney care for Black patients?
The best thing for patients to do is know their numbers, and visit a physician regularly for annual blood work and blood pressure reading. “Know where you are,” Baudy said. There’s great medication available for managing conditions like diabetes, high blood pressure, and kidney disease, which could prevent further complications like the need for a transplant down the line.
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When the news hit this spring that the first genetically modified pig kidney was successfully transplanted into a 62-year-old Black man in Massachusetts, medical and health communities celebrated. It lifted hopes about saving lives amid donation shortages — and opened a door of hope for reducing the health disparities that persist within organ failures and transplants.
Richard “Rick” Slayman died in May, two months after the procedure. There was “no indication” that his death was a result of the transplant, according to a statement by the hospital. He had high blood pressure and type 2 diabetes, which are two of the most common causes of kidney failure.
Still, there’s optimism that such a procedure could combat some of the continued health inequities.
Black Americans are almost four times more likely to suffer from kidney disease compared to white Americans. Because of this, they are overrepresented among dialysis patients. They make up more than 35% of patients, despite making up only about 14% of the U.S. population. For some patients with kidney failure, an organ transplant can be an ideal treatment, but shortages and barriers to access can limit options for Black folks.
One of the biggest debates about reducing health disparities has been the use of eGFR measurements to determine kidney function. It’s a formula that offers health care providers an indication of the health of a patient’s kidneys. But within the algorithm are equations that set a higher bar for Black patients, which can effectively drop them in organ transplant lists or prevent them from other interventions that could save their lives.
With that equation, “we actually have to be sicker to be diagnosed with the same illness as others,” said Dr. Naomi Nkinsi, who’s a family medicine residency physician in Washington state. She was among the medical students who fought during the height of the COVID-19 pandemic and racial justice protests to get the race correction removed.
Before receiving the transplant earlier this year, Slayman underwent a human kidney transplant but started to show signs of failure after a handful of years. That sent him back into dialysis treatment and recurring hospital visits to manage complications from his end-stage kidney failure.
Still, his story marks a significant development in xenotransplantation, which is the act of transplanting organs from one species to another. Here’s more about what this means for the future of health disparities for Black Americans:
What is the latest in terms of how health organizations are using the eGFR? Are most moving away from it?
Yes, many hospitals, medical groups and professional health organizations have already stopped incorporating race into their kidney function calculations. It’s been a long evolution, said Dr. Adrian Baudy, a kidney specialist in New Orleans. He remembers being a medical school student wondering why a patient’s race affected the algorithm’s output. “The answer was always, ‘This is what the studies show,’” Baudy said. “We’ve assumed for a really long time that African Americans had more muscle mass.”
This has a wide range of health implications, from diagnosis to a place on transplant lists and early health-related release from prison, Nkinsi said. Kidney function can also determine which medications are safe and unsafe for patients who are navigating other conditions.
When Nkinsi first learned about the potential consequences of using race in the equation, it got her blood boiling. She wondered why it seemed as though scientific accuracy wasn’t upheld to the same standard for Black patients. In school, she worried about retaliation and her career being at risk for speaking up. Hate mail was flooding in from Twitter, now X.
“It was an absolute fight,” she said. But now, “It’s one area where we’re seeing a distinctive step forward.”
What does the latest development of using genetically modified pig kidneys for transplants mean for Black patients? Could this save lives?
In the world of nephrology, or the study of kidneys, the idea of using organs from other species is not necessarily new, Baudy said. About a decade ago, various scientists began digging into the prospect of expanding into this world and, at that point, they thought this might come to fruition in 20 years. The progress has been rapid, he said. “We are in the future a little bit sooner than we anticipated.”
The progress is a significant step forward in expanding the number of organs available to those who are on wait lists. Because doctors want to match patients with donors that are most likely to be compatible, the wait can be long. On average, it’s about five years, Baudy said.
But with new means of transplantation, he’s optimistic that using other animal organs could knock down the wait to a year or two, or have some patients get transplants before needing dialysis. It could also open up the pool for older, sicker patients who may not be candidates for kidney transplants under traditional circumstances.
What it means is that more people who otherwise couldn’t get timely access may now benefit, he said. Nkinsi still worries about equity in access but is hopeful that the change in eGFR will trickle into transplants as well, meaning more Black patients will be eligible for the lifesaving procedure.
What’s the most urgent next step in terms of improving kidney care for Black patients?
The best thing for patients to do is know their numbers, and visit a physician regularly for annual blood work and blood pressure reading. “Know where you are,” Baudy said. There’s great medication available for managing conditions like diabetes, high blood pressure, and kidney disease, which could prevent further complications like the need for a transplant down the line.
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