DEI Priorities Create Havoc in Kidney Transplant System

2024-03-23 09:00:16

This week, Professor Jacobson discussed Diversity-Equity-Inclusion (DEI) crisis within the nation’s medical schools with Sandy Rios of American Family Radio, for her Sandy Rios 24/7 podcast.

And what we found is that CRT/DEI, whatever you want to call it, I call it the racialization of education, is deeply permeated throughout medical schools. And in some ways, it’s worse in medical schools than in higher ed in general. So we found out about it because we were interested more generally in the education topic, and then we started to get complaints and tips from people about medical schools.

The push for race-based preferences is impacting other areas of medicine as well. DEI readjustments are now being made for calculations based on the medical records associated with patients who have kidney issues and may require organ transplants.

The likely consequence of the new decision matrix that is intended to speed up transplants for black patients is the death of nonblacks who more urgently need the organs.

Kidney function is assessed by determining how efficiently the organs are removing creatinine, which is a chemical waste product of creatine. Creatine is a chemical made by the body and is used to supply energy mainly to muscles. Creatinine is removed from the body entirely by the kidneys.

When determining the advancement of kidney disease, doctors use an estimated glomerular filtration rate (eGFR) to determine how fast the kidneys are removing excess creatinine from the body, and the kidney transplant list uses the eGFR to determine the order in which patients would receive kidneys.

Rationally, the eGFR included an ethnicity-based calculation to account for the different normal levels of creatinine, so that really sick people would get transplants first, and people who were not sick would not get a transplant that they did not need.

Why was ethnicity a consideration in this calculation?

Because based on actual science, body composition differences (especially in muscle mass) mean that black people have higher serum creatinine concentrations than white people. In fact, there can be up to a six-fold difference. The following comes from a study published in the Clinical Journal of the American Society of Nephrology:

Adjusted mean serum creatinine concentrations were significantly higher in black versus nonblack patients (11.7 versus 10.0 mg/dl; P < 0.0001). Black patients were roughly four-fold more likely to have a serum creatinine concentration >10 mg/dl and six-fold more likely to have a serum creatinine concentration >15 mg/dl. Higher serum creatinine concentrations were associated with a lower relative risk for death (0.93; 95% confidence interval 0.88 to 0.98 per mg/dl); the association was slightly more pronounced among nonblack patients.

United Network for Organ Sharing (UNOS), a quasi-governmental nonprofit that runs American transplant centers, enacted a significant policy change. In 2020, a task force with the group decided (in the name of equity) to ignore the science and erase the ethnic adjustment from the formula that was originally being used.

Logic and reason would lead one to conclude that transplant organs would subsequently be heading to black patients with moderate kidney disease who might otherwise be able to wait. The nonblacks with severe kidney disease would be out of luck.

Paul T. Williams, a retired biostatistician with 25 years of experience as an extramural investigator for the National Institutes of Health, offered a chilling assessment of the likely consequences of this formula change.

The new formula sacrifices accuracy in the name of equity. A team of researchers, publishing in the Journal of the American Society of Nephrology, estimated that the new formula will deem more than 10 million nonblack patients to have either less severe chronic kidney disease or no disease at all—while deeming more than 1 million black patients to have more severe disease or to have disease for the first time. Because the new formula doesn’t include the necessary racial adjustments, however, these reclassifications misrepresent reality.

The human costs of this change will be severe. For every black patient who gains quicker access to treatment, ten nonblack patients risk losing such access. As those patients spend more time waiting for care or a new kidney, their conditions may worsen and bring some to the point of kidney failure, which, untreated, inevitably leads to death.

You would not give a person with type “O” blood a donation from someone with “AB” blood in the name of “equity.”  That would be lethal to the patient. Individuals have a wide range of differing body compositions, chemistries, and other factors that means medical decisions should be based on strictly on actual medical science.

Choices for patient care should not be based strictly on the racial box checked.

This formula change is toxic, and likely to kill patients needlessly. Hopefully, there will be a regulatory or legal remedy to this deadly and dangerous nonsense.


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DEI Priorities Create Havoc in Kidney Transplant System


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