Race, Racism, and Access to Renal Transplantation

End stage renal disease (ESRD) has become increasingly prevalent in the United States.  As a result, the number of patients in need of a kidney transplant, which is the optimal therapy for many ESRD patients, also continues to increase. However, the scientific research literature documents clear and compelling disparities in access to transplant based on patient race; yet the reasons for these disparities are complex and not well elucidated.

The purpose of this presentation is to describe a newly created conceptual framework for exploring the role that racism plays in creating and perpetuating racial disparities in access to renal transplant.  We present an overview of three theorized levels of racism (Institutionalized, Personally-mediated, Internalized)¹ and describe the ways in which they are manifested at each level of the social ecology (Intrapersonal, Interpersonal, Institutional, Community, and Public Policy) to propagate racial disparities in access to renal transplant.  Illustrative arguments draw from findings in the empirical research literature.  For example, the concentration of poor African Americans is a byproduct of policies and laws that were created to promote racial residential segregation; it creates communities plagued by high rates of chronic disease (including ESRD) that over time, have become characterized by a large number of dialysis centers with poor transplant rates.  Research findings demonstrate that dialysis centers in poor, Black areas tend to have lower transplant rates.²  This presentation will conclude with the identification of areas of research that are needed to further understanding the interplay of racism and renal transplantation.