Algorithm delays Black patients access to kidney transplants

The use of a race-adjusted algorithm delays Black patients' access to kidney transplant waitlists and transplants across the US, leading to significant disparities in care and health outcomes, according to researchers. What happened The estimated glomerular filtration rate (eGFR) calculation, which estimates kidney function, included a correction factor that artificially increased values for Black patients, making their kidney function appear better than it actually was. This delayed their referral and eligibility for transplant evaluation since transplant waitlist criteria require eGFR to be below a threshold (typically 20). As a result, many Black patients were placed on transplant waitlists later than appropriate, increasing their time on dialysis—leading to worse health outcomes, including higher mortality rates while waiting for transplants. It is estimated that this delay amounts to 1.3 to 1.9 years on average, during which disease progression worsened and some patients died or became too sick for transplant. Why it happened The race variable was integrated into eGFR formulas without clear intent to exclude Black patients but with unintended consequences of systemic racial bias. The variable was used for years despite growing evidence that it overestimated kidney function in Black patients. Limitations in transparency and accountability allowed this tool to persist in clinical practice, disproportionately disadvantaging Black patients. Race-based eGFR was prohibited for transplant eligibility purposes in July 2022, followed by a policy in 2023 allowing retrospective adjustment of wait time for affected Black candidates to account for lost time due to the race correction. However, these measures place the onus on transplant centers to identify and submit eligible patients for wait time correction, which may limit rectification scope. What it means For Black patients, the race-adjusted eGFR algorithm meant delayed access to life-saving kidney transplants, increased time on dialysis with declining health, and higher mortality risk. The new policies to remove race adjustments and modify wait times aim to improve equity but do not fully address the total harm, including those who died or became too ill while waiting. For society, the case highlights the critical need to reexamine race in medical algorithms, ensure transparency, accountability, and fairness in clinical tools, and advance equitable healthcare outcomes. It also underlines the importance of patient advocacy and policy reform to correct systemic racism embedded in healthcare systems. System 🤖 eGFR 🔗 Developer: Country: U SA Sector: Hea lth Purpose: Assess kidney function Technology: Statistical algor ithm Issue: Accountability; Accuracy/reliability; Bias/discrimination; Transparency

Product, system or model

eGFR

This is a record of what was reported, not a finding that anyone broke the law. If it names your organisation and you believe it is wrong, the corrections process is free and open to everyone.