Quite surprisingly, researchers have found that fewer racial issues arise when kidneys are donated after cardiac death compared with kidney donations made after brain death. Hence, kidneys donated after individuals die from cardiovascular causes may be one of the best options for black patients in need of transplants.
The research, which appears in the October 2008 issue of the Journal of the American Society Nephrology (JASN), reveals that utilization of these organs should be expanded in order to reduce racial disparities that exist in renal transplantation.
Numerous studies have shown that persistent
disparities exist in end-stage renal disease (ESRD) and kidney transplantation.
Black patients with ESRD comprise more than a third of the kidney transplant
waiting list but are 2.7 times less likely to receive a kidney transplant than
their white counterparts. In addition, black patients are more likely to
experience kidney failure after transplantation compared with whites.
There is a clear shortage of donor kidneys
in the United States, and there are currently more than 70,000 Americans
waiting for kidney transplants. Kidneys donated after brain death are currently
used for transplantation, but rarely are organs donated after cardiac death.
Researchers say that increased recovery and utilization of kidneys donated
after cardiac death could help boost the supply of organs available for
transplantation. However, it is unclear whether the racial disparities seen in
donations made after brain death would also be seen when donations were made
after cardiac death.
To examine the issue, Daniel Warren PhD, and
Jayme Locke MD, MPH, of the Johns Hopkins Medical Institutions and their
colleagues looked at the outcomes of more than 100,000 adults who received a
deceased donor kidney transplant between 1993 and 2006.
Among black patients, those who received
kidneys from black cardiac death donors had better long-term kidney and patient
survival than those who received kidneys from non-black donors. In addition,
compared with standard-criteria kidneys from white donors after brain death,
kidneys from black donors after cardiac death conferred a 70% reduction in the
risk of kidney loss and a 59% reduction in risk for death among black
The investigators found that racial
disparities were less profound when kidneys were donated after cardiac death
compared with kidney donations made after brain death. "These findings suggest
that kidneys obtained from black donors after cardiac death may afford the best
long-term survival for black recipients," the authors conclude.
The authors note that the findings also indicate
that increased utilization of kidneys donated after cardiac death has the
potential not only to reduce the organ shortage but also to mitigate the
existing disparities for black kidney transplant recipients. They add that the
racial disparities in organ and patient survival after kidney transplantation
need further investigation.