The Health Divide: Blacks are four times more likely to develop kidney failure than whites

Published on
December 18, 2023

For as long as Tyrone Dumas can remember, he has carried the bubble on the back of his Wisconsin driver’s license to be an organ, eye, and tissue donor. 

It was the easy way for Dumas to become a donor, and he hoped if anything tragic happened to him, his organs could be used to help preserve someone else’s life. 

Now, at 71, Dumas is the one in need of a life-saving organ. He needs a kidney. 

In November, Dumas received the news he had been waiting for: He had been added to the kidney donor list at a local health care system.  

In a Facebook post, Dumas wrote: “I am nervous as I write this post because I got some positive information yesterday… after one year of extensive tests, I have qualified to be on the Froedtert/MCW kidney transplant list… I’m hopeful with this new chance at continued life … .” 

Dumas, a former Public Works director at Milwaukee County Courthouse, said he knew the odds were against him. African Americans are four times as likely to develop kidney failure when compared to their white counterparts, and they are also less likely to receive a lifesaving kidney transplant. 

Part of the disparity can be explained by the fact that African Americans have higher rates of comorbidities that lead to kidney failure. African Americans have the highest rates of hypertension, high cholesterol, diabetes, and obesity compared to other racial groups. All these factors contribute to kidney failure.  

As Dumas waits for the phone call saying a kidney match is available, he continues to prepare himself for the lifesaving organ that will give him a new lease on life. 

“Right now, I am mentally preparing myself,” he said.  

‘You can’t get frustrated’ 

Dumas described the process of getting on the kidney transplant list is a daunting one that requires the person in need of the organ to undergo a series of tests, interviews with medical staff, and, most of all, a test of patience. 

“It’s an exhausting process,” Dumas said. “But you can’t get frustrated.” 

It took Dumas a whole year to get on the list. The process started in November 2022, when Dumas and his wife, Ceciel, went to Froedtert Hospital in Milwaukee for interviews, where physicians asked him about his diet, exercise and overall health.  

Next, he met with each member of the surgical transplant team, and they described in detail what would take place during the transplant, what post-surgery care would require, possible side effects and the potential for organ rejection. 

He also had to undergo a bevy of medical exams, including a liver biopsy, to see if his body could handle the surgery.  

Then, every month, he went in for more testing. 

“The thing I found interesting is when they wanted to know how good I was at following directions,” Dumas said. 

Dumas, who has stage 3 kidney failure, was told that after he receives a kidney, he will still need to closely monitor his vitals at home for months afterward to ensure everything is functioning the way it should. 

Kidneys are the unique filter system that removes wastes and extra fluid from the body. The organs also help regulate acid-base balance, maintaining the proper amount of water, salts, and minerals in your blood. The bean-shaped organs also play a central role in controlling blood pressure. 

After leaving the hospital, those who receive a kidney must keep track of their fluids, monitor how much urine they produce, and keep tabs on their temperature, blood pressure, and weight changes. 

People who receive a kidney also have a higher chance of getting infections because immunosuppressant medicines weaken one’s immune system. 

“You get a lot of information, and that’s why it’s important to have an advocate with you to write down most of the things they tell you,” Dumas said. 

Now that he’s on the list, Dumas is counting down the days when he will no longer need to speed three days a week, three to five hours per treatment, at the dialysis facility. 

Being in the “waiting mode” means Dumas has put any plans for travel on hold. 

“You never know when that phone will ring, and I want to be ready,” he said. 

86% of patients waiting for an organ need a kidney 

Across the United States, more than 88,500 people are on the waiting list for a kidney transplant as of September 2023, according to the Health Resources and Services Administration (HRSA). 

About 86% of those waiting for an organ are waiting for a kidney. 

Through September, nearly 16,000 people have received a kidney transplant.  

A majority of those waiting for an organ are over the age of 50, while more than 41,000 people are white and nearly 29,000 are Black. There are 22,600 Hispanic people on the waiting list, 8,700 Asian, 897 American Indians, and 604 Pacific Islanders. 

There are more people on the waiting list for a kidney than for a liver, pancreas, heart, lung, and other organs combined, according to HRSA. 

For Dumas, other health issues make finding a donor essential. He takes insulin for his diabetes, and he admits he wishes he could be more physically fit. 

While African Americans are far more likely to be diagnosed with renal failure as whites, the disease is usually caught late, and as a result, it takes longer for them to be added to the transplant list. Black people make up 13% of the population but account for 30% of the people with end-stage kidney disease.  

But African Americans do not suffer alone. Since 2000, the number of Hispanics, Native Hawaiians, Pacific Islanders, and Asian people with kidney failure has more than tripled in each group, according to the National Institute of Diabetes and Digestive and Kidney Diseases.  

There are several factors leading to the gap between whites and Blacks when it comes to kidney disease. They include: 

  • Systemic racism within and outside of the health care system can make it harder to catch conditions early and get quality care when problems arise. 
  • Distrust in the medical system: People of color have been traditionally left out of the health care system and may distrust it as a result. This makes talking to patients of color about preventive care harder. 
  • Chronic disease and environmental factors: Communities of color have higher rates of diabetes, high blood pressure and obesity, and well as higher rates of chronic stress and less access to parks and safe areas to stay fit.  
  • Urban myths: There are many African Americans who believe that if they agree to donate their organs if they are involved in an accident, that hospitals will not do what they can to save their lives so they can harvest their organs. 
  • Making a match: Transplants are done between people of different ethnicities, but the chance of longer-term survival can be higher if the donor and recipient share similar genetic backgrounds. 

Dumas's half-brother, Anthony, is getting tested to see if his kidney matches. 

“If he’s a match, my prayers will be answered, but if he’s not, the search continues,” Dumas said. 

Removal of antiquated kidney tests will help Blacks 

In February, NBC News published a report that showed African American patients have had to wait longer for kidney transplants than other races because of an outdated test that overestimated their kidney function. 

The antiquated kidney function test, known as estimated glomerular filtration rate test or eGFR, can overestimate kidney function in Black patients, masking the severity of their disease and resulting in late diagnosis and delayed transplant referrals, as USA Today reported.

In January, the Organ Procurement and Transplant Network called for a ban on the eGFR test and instructed every kidney transplant program to credit affected Black patients with time. 

This move could save someone like Dumas's life because his waiting time would be reduced. 

White patients added to the kidney wait list in 2014 waited on average 37 months, compared to 64 months for Blacks because of the outdated and biased test, NBC reported. 

“We are hoping this will be an example of a restorative justice in medicine,” said Dr. Martha Pavlakis, nephrologist and member of OPTN Kidney Transplantation Committee. 

Regardless of the outdated test, Dumas said being added to the transplant list has given him the mental boost he needed for his health. 

Over the past two years, he said he has adjusted his diet. He has cut his salt intake. He’s exercised more and cut out sugary drinks and snacks, but he still struggled with his numbers. 

When he started dialysis in August, he was at his low point. 

“It was tough on me, and I was wondering if things could get even worse,” he said. 

The one thing that kept Dumas going was celebrating his 50th wedding anniversary with his wife with family and friends and praying that he could find a matching kidney. 

“I feel pretty good that this will end well,” he said. “I’m just waiting by the phone for some good news.”