In our medical system today, two patients can have identical symptoms, be in similar condition, and need the exact same transplant, yet one of these patients will be allowed to die. Shockingly, this decision is made on the basis of race, zip code, or class. “Unfair” would be an understatement. In the U.S., more than 48,000 organs are transplanted each year, yet 13 people die each day from a lack thereof. Currently, there are 103,223 people on the waiting list, and sadly, the rich white patient who resides near a hospital will steal a heart from a poor person of color who is lying on their deathbed.
Even getting on the wait list is consistently a challenge for Black patients. To get on the wait list, there is an evaluation process from a physician; however, the process is derived from a system still being poisoned by prejudice and racist medical practices from the past. There are specific standards that must be met, but they are noticeably lower for white patients than for Black patients.
The circulation of a false, out-of-date theory that Black patients’ muscle mass is higher and a 2011 study that deemed Black patients as “medically unfit” drive these disparities. Although many hospitals are shifting away from these judgmental methods, they continue to taint their chances of making the wait list. Due to this, it is half as likely for a Black patient to make the waiting list as a White patient. This is a representation of medical racism: the lingering disparities and systemic effects that people of color face in medicine today due to past racist experiments and ideals.
If these candidates can’t even climb the first step on the way to recovery, did they ever have a fair shot at survival in the first place?
Once on the waiting list, non-white patients stay on for a drastically longer time. In 2014, the median wait time for Black recipients was 19.8 months, while White recipients only waited for 12.3 months. While the numbers reduced in 2016, the disparity in wait time remained: 10.1 months compared to 8 months. Those few crucial months could be the deciding factor in life or death, leaving someone’s fate up to a wait list.
Beyond just the wait list, people of color are four times more likely to have kidney failure, but ironically, less likely to receive a kidney via transplant. Similarly, non-white patients experience the highest amount of heart failures, but sadly receive fewer donor organs than White people.
Typically, Black and brown Americans are disproportionately exposed to environmental hazards due to housing injustice, and are therefore more likely to develop medical issues, not just organ failure.
While patients don’t need to be matched based on race, it often affects availability because of genetic similarities. Only a small sliver of accessible organs comes from people of color, at around 35%, even though non-white patients make up more than half of the wait list.
The first step in obtaining a suitable organ match is for the hospital to contact the organ procurement organizations (OPOs). Then the OPO has the decision of following up. Tragically, OPOs are half as likely to follow up with a family of color as a white family. This racial bias means that patients are systematically denied access to potential donor programs, costing the lives of innocent people for just the color of their skin.
Alongside racism, socioeconomic status has a punishing effect when it comes to organ donation. Uninsured and under insured patients face excessive costs to live healthily. Regardless of government-funded insurance, like Medicare or Medicaid coverage, transplant recipients who live in poverty will be expected to pay $300 to $400 per month. However, they are only supported for a few months. Every month after that, it will be thousands of dollars a month, or hundreds of thousands of dollars over 10 years. And without insurance, prices of kidney transplants to hearts range from an expensive $400,000 to $1.7 million. These costs will go unpaid while patients are restricted from working post-transplant.
This poses a significant barrier for poor patients in need of a transplant. Including surgery and medications, some people can’t afford to stay alive; literally.
Furthermore, even living in rural and remote areas leaves someone susceptible to the dangers of discrimination within the organ transplant industry. The average costs of organ transplantation are inhumanely high, even without the distancing costs. Adding in additional expenses for travel and lodging of the patient and organs raises these prices to a new extreme. A 2024 study in JAMA Surgery, from Vanderbilt University Medical Center, highlighted an insane 77% price increase for fly-outs—organs that required airplane transport due to their far location.
Also, like people of color, residents of rural and remote areas experience higher rates of chronic kidney disease and kidney failure and a higher death toll from it. This mortality rate is almost double that of cases in urbanized areas. Unfortunately, they have a lower chance of qualifying for the wait list and, therefore, are less likely to receive a kidney.
Countless stories of life being left up to a broken system, and barely any representation or accountability. Right now, there are people of color who live in remote, impoverished areas, while suffering from kidney disease, and because of this system, they aren’t going to survive. Until we confront the racial, socioeconomic, and geographic inequities embedded in our transplant system, thousands will continue to die, not from a lack of medical possibility, but from a lack of fairness.
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