Are We Still Worlds Apart? Racial and ethnic disparities in kidney transplantation November 16, 2015 Vanessa Grubbs, MD, MPH Assistant Professor Division of Nephrology UCSF/ San Francisco General Hospital

“Most of the White patients here either have had transplants or are going to have transplants. Most of the African American men here aren’t. They’re kind of in it for the long haul.” Robert Phillips Worlds Apart

This isn’t new… 3 Alexander and Sehgal. JAMA *Adjusted for gender, zip code income, age, cause of renal failure, and years on dialysis

…and it hasn’t changed (yet) Organ Procurement and Transplantation Network (OPTN) 4

Blacks and Hispanics wait longer 5 Organ Procurement and Transplantation Network (OPTN)

Is it because of how kidneys are allocated? 6 Organ Procurement and Transplantation Network (OPTN)

Is it because of who is donating kidneys? Organ Procurement and Transplantation Network (OPTN) US Census Bureau 7

Rate* of incident ESRD in Blacks 3X that of Whites United States Renal Data System (USRDS) Atlas 2015 ESRD, end-stage renal disease *adjusted for age and sex 8

What can we do?  Disparities in who gets ESRD  Disparities(?) in who donates kidneys  Disparities in access to wait list 9

Disparities in who gets ESRD  Genetics?  Access to healthy food  Access to safe neighborhoods  Access to clean air  Access to good education  Access to good jobs  Access to health care 10

Disparities(?) in who donates kidneys  Prevention  Public awareness about dialysis and ESRD  Public awareness about who can donate to whom  Public awareness about donor evaluation 11

Disparities in access to wait list  Patient education  Standard referral  Transparency 12

Shameless plug  Blog: thenephrologist.com   Book: TETHERED: a doctor’s story of love, donation, and dialysis 13