A long-standing inequity in U.S. kidney transplantation is beginning to narrow for Black patients. The improvement follows policy changes that removed race from clinical formulas used to estimate kidney function—formulas that for decades tended to overestimate kidney health in Black patients, delaying diagnosis, referral, and ultimately access to transplant waiting lists.
Researchers reported in JAMA Internal Medicine that updated policies have had a measurable, positive impact: Black patients with kidney failure are receiving more transplants and spending less time waiting. Study leader Dr. Rohan Khazanchi (Brigham and Women’s Hospital and Boston Medical Center) said the findings support “reparative approaches” to address harms caused by race-based clinical algorithms.
The shift traces back to changes in how estimated glomerular filtration rate (eGFR)—a key marker of kidney function—was calculated. Historically, some eGFR equations included a race adjustment that effectively required Black patients to have worse renal function than white patients to reach the same diagnosis thresholds for kidney disease and transplant eligibility steps. In 2021, race was removed from equations used to estimate kidney function as part of efforts to address this inequity.
But changing the formula alone couldn’t undo the backlog of patients already disadvantaged by earlier assessments. That’s why, after race-neutral eGFR policies took effect, U.S. transplant programs were required to review transplant candidates and correct waiting times for Black patients who may have been delayed by the race-inclusive calculation. The OPTN/HRSA guidance explains that kidney programs had to assess waiting lists and submit “waiting time modifications” for eligible Black candidates affected by the older approach.
As of June 2025, 21,119 Black patients waiting for kidney transplants had been moved up on waiting lists. The study found this corresponded to an increase of 5.3 transplants per 1,000 Black candidate listings, while transplant rates among non-Black and/or Hispanic candidates did not change significantly. In other words, the improvement for Black patients was not associated with a measurable drop for others in the study’s analysis.
Clinicians said that, in some cases, people who had been on dialysis for years received a transplant within months after reassessment using race-neutral formulas—patients who otherwise might still have been years away from the top of the list under the old system.
Even with these gains, the researchers caution that inequities have not disappeared. Khazanchi emphasized that Black patients and other marginalized groups still face unequal access despite higher rates of end-stage kidney disease, and he called for continued accountability and intervention. The recent efforts to stop collecting race and ethnicity data in the U.S. Renal Data System could make it harder to track disparities and measure progress going forward.
