This weekend I visited the Mount Sinai School of Medicine on the Upper East Side of Manhattan. Among many other interesting sessions, the faculty presented a session aimed to highlight health disparities. The specific topic was kidney transplantation. The brief conversation that took place made me want to do a bit of research and learn more about kidney disease and transplantation.
Certain diseases such as diabetes and high blood pressure can greatly damage kidneys. Unfortunately, minority populations are disparately affected by these diseases and thus by kidney disease. According to statistics from the University of Cincinnati, the number of new kidney failure cases diagnosed in 1997 was 873 per million in African Americans and 218 per million in whites; 73% of all cases among African Americans resulted from high blood pressure and diabetes; African Americans made up about 13% of the US population but 30% of all kidney failure cases. Obesity, diabetes and high blood pressure among African Americans has become a bigger problem since 1997, and today the health disparities continue to be rampant.
Kidneys are organs essential to life as they filter toxins from our
blood, regulate our blood pressure and help our bodies remain healthy. High
blood pressure and high levels of sugar in
the blood can damage the blood vessels within the kidney. Once damaged, the
kidney cannot keep useful substances (like proteins) in the blood. If protein
is instead found in urine, it can be the mark of kidney disease.
Over time, kidney disease gets worse and worse. Chronic kidney disease
progresses to end-stage kidney disease in which these vital organs completely
shut down. When this happens, hemodialysis (an artificial process that filters blood) can be a life-saver. However, over
time the hemodialysis process also takes a toll on the patients’ body and quality of
life. Many patients must spend up to four hours a day on hemodialysis which interferes with their daily lives. Patients leave
the clinic feeling exhausted. Hemodialysis patients must also follow a strict
diet which may be especially difficult for patients who already have
uncontrolled blood pressure and diabetes. For people with end-stage kidney
disease, organ transplantation may be their only chance at life; many die waiting for an organ.
Organ transplantation is not a cure-all solution. Finding a good organ match, undergoing the surgery and the aftercare that is required are difficult processes. According to Dr. Susan Lerner, a transplant surgeon at Mount Sinai, New York State has one of the longest waiting periods for a kidney. This is the result of a higher number of people needing a kidney combined with a fewer number of donors. While patients wait to be matched to a donated kidney, they can spend more than five years on hemodialysis and remain very ill.
Some studies have found that minority patients are less likely to be referred for kidney transplantation by their physicians. Even if referred, patients must pass a series of physical and mental health assessments. The tests also seek to evaluate the patient's emotional support system and the likelihood that the patient will adhere to the post-operative care plan, including taking prescribed medications. Aside from passing these screening processes, patients must match to a donor-kidney with similar tissue and blood type. Finally, the financial aspects of the surgical procedure must be sorted out before the transplantation can take place. The entire screening, match and transplant process can take nine years!
Social determinants of health such as socioeconomic background and level of education can interfere with a minority patient's ability to pass the physical and mental health tests. Furthermore, the process is long and arduous and many minorities fail to even complete the testing process. Even though African American patients are not required to be matched to organs from African American donors, minorities do not donate organs and tissues at the same rate as their white-counterparts. This fact only decreases the likelihood of minorities finding a perfect match.
Lack of financial resources can also affect a patient's ability to find an donor-organ match. Consider the case of the late Steve Jobs, co-founder and former chairman of Apple, Inc. Mr. Jobs came from an affluent background and was thus able to benefit from being on liver transplant waiting-lists in multiple states. Since he was on multiple lists, Mr. Jobs was able to find a match more quickly and travel to Tennessee to undergo the transplant operation. I am sure that many Americans cannot afford this luxury. Furthermore, after organ transplantation, the medications necessary to prevent the body from rejecting the organ and to treat infections, cost a lot of money. Health insurance, even public health insurance, can help cover the cost of the medication but often cannot cover everything. A patient who actually underwent kidney transplantation visited students at Mount Sinai and said that he had cleaned out his savings of more than $20,000 to pay for one year's medication.
For all that has been described here, it is very important for the medical community and society at large to work harder to raise awareness about health disparities. We must keep raising awareness to encourage research and policy change necessary to help eliminate the growing gap in health equality.
Some studies have found that minority patients are less likely to be referred for kidney transplantation by their physicians. Even if referred, patients must pass a series of physical and mental health assessments. The tests also seek to evaluate the patient's emotional support system and the likelihood that the patient will adhere to the post-operative care plan, including taking prescribed medications. Aside from passing these screening processes, patients must match to a donor-kidney with similar tissue and blood type. Finally, the financial aspects of the surgical procedure must be sorted out before the transplantation can take place. The entire screening, match and transplant process can take nine years!
Social determinants of health such as socioeconomic background and level of education can interfere with a minority patient's ability to pass the physical and mental health tests. Furthermore, the process is long and arduous and many minorities fail to even complete the testing process. Even though African American patients are not required to be matched to organs from African American donors, minorities do not donate organs and tissues at the same rate as their white-counterparts. This fact only decreases the likelihood of minorities finding a perfect match.
Lack of financial resources can also affect a patient's ability to find an donor-organ match. Consider the case of the late Steve Jobs, co-founder and former chairman of Apple, Inc. Mr. Jobs came from an affluent background and was thus able to benefit from being on liver transplant waiting-lists in multiple states. Since he was on multiple lists, Mr. Jobs was able to find a match more quickly and travel to Tennessee to undergo the transplant operation. I am sure that many Americans cannot afford this luxury. Furthermore, after organ transplantation, the medications necessary to prevent the body from rejecting the organ and to treat infections, cost a lot of money. Health insurance, even public health insurance, can help cover the cost of the medication but often cannot cover everything. A patient who actually underwent kidney transplantation visited students at Mount Sinai and said that he had cleaned out his savings of more than $20,000 to pay for one year's medication.
For all that has been described here, it is very important for the medical community and society at large to work harder to raise awareness about health disparities. We must keep raising awareness to encourage research and policy change necessary to help eliminate the growing gap in health equality.
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