Rebuilding Trust, Increasing Living Donor Transplant In Black Kidney Candidates, With Pranav Garimella, MBBS, MPH

While recent national policy aimed to repay a historical debt for black kidney transplant candidates who were disadvantaged by race-based eGFR, the structural barriers to living donor kidney transplants remain.

“The study improved overall transplantation rates in persons who identify as Black, particularly for preemptive transplantation, but it did not increase living donor transplants,” Pranav Garimella, MBBS, MPH, Chief Medical Officer of the American Kidney Fund and an associate professor of medicine at UC San Diego, told HCPLive. “That highlights a persistent gap driven in part by historic mistrust in the medical system, and underscores the need to build trust and improve access to living donor transplantation.”

Historically, these patients had been marginalized by race-based kidney function equations for decades, which misrepresented the measure of their kidney function. The 2023 Organ Procurement and Transplantation Network (OPTN) national policy restored waitlisting time, and successfully saw an increase in transplants for Black kidney candidates of 5.3 transplants per 1000 listings. Meanwhile, the OPTN data also pointed out that after the initial spike, transplant rates have begun to decline again, with experts suggesting structural barriers remain a looming challenge in getting historically marginalized patients onto transplant lists.

While the number of patients who would benefit from a living donor kidney transplant continually outpaces the number of available organs, access remains disproportionately available to those based on their race.

For example, despite increased rates of end-stage kidney disease in patients who are black, these patient recive living donor kidney transplants significantly less frequently than those who are white. Furthermore, black patients are less likely to be referred for kidney transplant evaluation and less likely to be added to a waitlist.

“A critical bottleneck in transplantation is the limited availability of donor kidneys—especially from living donors—so expanding access through community engagement, supportive policies, and addressing financial concerns for donors will be essential to meaningfully increase transplant rates, particularly in historically marginalized populations,” concluded Garimella.

Editor’s Note: Garimella has relevant disclosures with Otsuka and the PKD Foundation.

References

1. Khazanchi R, Fleishman A, Eneanya ND, et al. Wait Time Modifications for Black Transplant Candidates Affected by Race-Based Kidney Function Estimation. JAMA internal medicine. Published online September 2026:e260001. doi:https://doi.org/10.1001/jamainternmed.2026.0001

2. Garimella P. How Rewriting Race-Based GFR Equations Changed Kidney Transplant Access, With Pranav Garimella, MBBS, MPH. HCPLive. Published March 31, 2026. https://www.hcplive.com/view/rewriting-race-based-egfr-equation-changed-kidney-transplant-access

3. Garimella P. OPTN Policy Gave Back Time, Increased Transplants for Black Kidney Candidates So Why Have Rates Plateaued? HCPLive. Published April 2, 2026. https://www.hcplive.com/view/optn-policy-gave-back-time-to-waitlisted-black-kidney-candidates-but-transplant-rates-are-declining

4. Suah A, Saunders MR. Racial Disparities in Living Donor Kidney Transplantation—How Can We Bridge the Gap? JAMA Network Open. 2023;6(12):e2347808. doi:https://doi.org/10.1001/jamanetworkopen.2023.47808