Race-Neutral Kidney Transplant List Rules Have Helped 20,000 Black Patients, Doctor Says

A doctor specialising in transplant medicine has described the real-world effect of changes to how kidney waiting-list time is calculated in the United States. Shazia Siddique, MD, MSHP, says more than 20,000 Black patients have received retroactive time adjustments on the waiting list since race-neutral criteria were introduced — and that thousands have gone on to receive kidney transplants as a direct result.

The comments were made in a discussion published by the New England Journal of Medicine (NEJM), one of the world’s most widely read medical journals. Dr Siddique described the changes as having a positive impact on transplant access for Black patients, who had previously accumulated waiting-list time under a system that factored race into kidney function measurements.

The older method used a calculation called eGFR — estimated glomerular filtration rate, a measure of how well the kidneys are filtering blood — that applied a race-based adjustment. Critics argued this adjustment systematically underestimated kidney disease severity in Black patients, meaning they were less likely to be listed for transplant as quickly as white patients with equivalent kidney function.

Removing that adjustment means patients’ kidney function is now assessed using the same formula regardless of race. For those already on the list, waiting time has been recalculated retroactively — which is how more than 20,000 Black patients came to receive additional credited time without having waited any longer in practice.

The NEJM discussion does not set out UK policy. NHS Blood and Transplant, which manages the UK transplant waiting list, uses its own matching and prioritisation criteria. Anyone with concerns about kidney disease or transplant eligibility should speak to their renal (kidney) specialist or contact NHS 111.