Health Care Financing Administration Wants to Make Kidney Transplant Availability Equal, Regardless of Race
The federal Health Care Financing Administration (HCFA) plans to increase education regarding and the oversight of renal dialysis facilities to ensure that all races, including African-Americans, have the opportunity to be evaluated for kidney transplantation.
Key among the provisions of the program are an effort to communicate with dialysis centers about their responsibility under federal regulations to ensure that all patients in their facility are assessed for possible kidney transplantation and are told whether they are candidates for such a procedure. “Medicare rules require that all patients with kidney failure be evaluated and informed about transplantation,” said HCFA administrator Nancy-Ann DeParle. “We want to be sure this is happening and be sure there is equal opportunity for transplantation when needed, regardless of a patient’s race.”
The HCFA announcement came in the wake of the publication of an article in the New England Journal of Medicine that found that African-American patients with end-stage renal disease were less likely to want or to be referred for a transplant than their white counterparts (Ayanian JZ, Cleary PD, Weissman JS, Epstein AM. The effect of patients’ preferences on racial differences in access to renal transplantation. N Engl J Med. 1999;341:1661–1669).
The researchers interviewed 1392 patients who ranged in age from 18 to 54 years. Of these patients, 384 were African-American women, 354 were white women, 337 were African-American men, and 317 were white men. They found that 76.3% of African-American women wanted a transplant, whereas 79.3% of white women did, and that 80.1% of African-American men wanted a transplant, as compared with 85.5% of white men. Larger differences were found in the referral rates among the races. Only 50.4% of African-American women were referred for transplant, as compared with 70.5% of white women, and only 53.9% of African-American men were referred for transplant, but 76.2% of white men were. Similar differences were seen in the rates at which patients in the 2 races were put on waiting lists for transplantation. The researchers noted that the differences remained significant after adjustment for the patients’ preferences and expectations about the success of transplantation, their sociodemographic characteristics, and the type of dialysis facility in which they were treated.
In another article in the same issue of the New England Journal of Medicine, Dr Garg and his colleagues found that patients treated at for-profit dialysis facilities had increased mortality and decreased rates of placement on the waiting list for a kidney transplant compared with patients treated at facilities with a nonprofit ownership (Garg PP, Frick KD, Diener-West M, Powe NR. Effect of the ownership of dialysis facilities on patients’ survival and referral for transplantation. N Engl J Med. 1999;341:1653–1660). However, Dr Ayanian and his colleagues did not find such an association in their patients, who were studied within 18 months of entering dialysis.
In addressing the racial disparity, HCFA, which pays for both dialysis and kidney transplants under its Medicare program, will do the following:
Remind all certified dialysis facilities that all of their patients are to be assessed for transplant and informed about the possibility of transplant.
Instruct state survey agencies charged with enforcing HCFA rules to pay particular attention to dialysis facilities and their compliance with the regulations.
Work with networks and support groups for patients with end-stage renal disease to determine how these groups can help patients and dialysis facilities increase rates of transplant assessment in their area of the nation.
- Copyright © 2000 by American Heart Association