I am so glad to see a discussion around the inequities in kidney transplantation in the article “Strategies to Guide Preemptive Waitlisting and Equity in Waittime Accrual by Race/Ethnicity,” published in this issue of CJASN.1 This is a topic that needs ongoing thought and discussion to make impactful changes. I found interest in the approaches and considerations for preemptive waitlisting within the study by Ku et al.1 In theory, the idea of using a race-free equation to determine the timing of listing someone may seem to create a fair opportunity for access in comparison with other strategies; however, I believe both models highlighted in this study are somewhat short-sighted and lack a real-world vision.

As a Black woman who sat in a dialysis chair for nearly 9 years during her mid-20s, I must share that culture, race, and ethnicity are leading factors that contribute to the lack of efficiency, quality, and timeliness of medical care in general, but especially in this area of medical care. As a healthy young person, the need for a kidney transplant occurred shortly after the diagnosis of lupus. Waiting was a key reason for my life-threatening experience. My laboratory findings were initially deemed as insubstantial, and I was required to wait 3 months before receiving care from a nephrologist. Above this, I experienced implicit bias when I shared that I believed the changes in my health were caused by lupus. I asked to be tested for this and was met with a dismissive approach.

Studies show that minority populations often have more aggressive experiences with chronic disease in comparison with the White community. Hence, timely treatment is needed. As a public health professional who now educates people living with a chronic illness, I have observed that minorities, specifically the Black and Hispanic communities, do not have time on their side to achieve good outcomes. The sooner they can be listed, the sooner they can receive the therapy.

In addition, reducing inequities requires a true look at the impact of race and the social determinants of health that prevent an individual from implementing best practices, staying consistent with treatments, and working with the medical community. Minorities have stress factors and unique experiences that should not be wiped out by an equation.

Finally, trust must be factored in to provide equitable opportunities in this process. The Black community struggles with trust of the medical community and often hesitates to receive the necessary care. This history also must be acknowledged, and sincere efforts must be made to help minority patients feel that the goal of organ transplant is achievable by getting waitlisted in a timely manner because multiple risk factors lead to the urgency.

Disclosures

The author has nothing to disclose.

Funding

None.

Acknowledgments

The content of this article reflects the personal experience and views of the author and should not be considered medical advice or recommendation. The content does not reflect the views or opinions of the American Society of Nephrology (ASN) or CJASN. Responsibility for the information and views expressed herein lies entirely with the author.

Author Contributions

Writing – original draft: Wendy Rodgers.

Reference 1. Ku E, Copeland T, Chen L-X, et al. Strategies to guide preemptive waitlisting and equity in waittime accrual by race/ethnicity. Clin J Am Soc Nephrol. 2024;19(3):292–300. doi:10.2215/CJN.0000000000000354