African-Americans with End Stage Renal Disease in the Early Years of Kidney Transplantation

• Published in: Journal of the National Medical Association Vol. 111; no. 4; pp. 352 - 362
• Main Authors: Wang, Jackie Y., Lederer, Susan E., Ross, Lainie Friedman
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2019; Elsevier Limited
• Subjects: African Americans; African Americans - history; African Americans - statistics & numerical data; Decades; Dialysis; Disparities; End stage renal disease (ESRD); Epidemiology; Ethnicity; Health care access; Health care policy; Health Services Accessibility - history; Healthcare Disparities - ethnology; Healthcare Disparities - history; Hemodialysis; History; History, 20th Century; Humans; Hypertension; Information sources; Kidney diseases; Kidney Failure, Chronic - ethnology; Kidney Failure, Chronic - history; Kidney Failure, Chronic - surgery; Kidney transplantation; Kidney Transplantation - history; Kidney transplants; Medicare - history; Medicare - legislation & jurisprudence; Patients; Physicians; Race; Race/ethnicity; Renal replacement therapy; Segregation; Surgeons; Transplants & implants; United States; United States; ESRD; ACS-NIH; UAGA; NAACP; African-Americans; End stage renal disease (ESRD); UCLA; Race/ethnicity; IOM; Disparities; History; Kidney transplantation
• ISSN: 0027-9684; 1943-4693
• DOI: 10.1016/j.jnma.2019.01.005

Introduction. The first successful kidney transplant in humans was performed in 1954. In the following 25 years, the biomedical, ethical, and social implications of kidney transplantation were widely discussed by both healthcare professionals and the public. Issues relating to race, however, were not commonly addressed, representing a “blind spot” regarding racial disparities in access and health outcomes. Methods. Through primary sources in the medical literature and lay press, this paper explores the racial dynamics of kidney transplantation in the 1950–1970s in the United States as the procedure grew from an experimental procedure to the standard of care for patients in end-stage renal disease (ESRD). Results & Discussion. An extensive search of the medical literature found very few papers about ESRD, dialysis, or renal transplant that mentioned the race of the patients before 1975. While the search did not reveal whether race was explicitly used in determining patient access to dialysis or transplant, the scant data that exist show that African-Americans disproportionately developed ESRD and were underrepresented in these early treatment populations. Transplant outcome data in the United States failed to include race demographics until the late 1970s. The Social Security Act of 1972 (PL 92-603) extended Medicare coverage to almost all Americans with ESRD and led to a rapid increase in both dialysis and kidney transplantation for African-Americans in ESRD, but disparities persist today.