Access to renal transplantation among American Indians and Hispanics

Background: African Americans have decreased access to renal transplantation compared with whites. Whether similar barriers exist for American Indians or Hispanics is not well defined. 

Methods: The authors identified a total of 1,335 patients ages 20 to 59 years without prior renal transplantation undergoing dialysis in December 1994 in Arizona and New Mexico. For each patient, information was collected on identification as a potential candidate for renal transplantation, referral to a renal transplantation center, completion of 4 stages in the evaluation process, and receipt of a transplant over 7 years. 

Results: American Indians were more likely than whites to be identified as potential candidates (relative risk [RR] 1.30, 95% confidence interval [CI] 1.15 to 1.44) and to be referred to a transplant center (RR 1.16, 95% CI 1.09 to 1.19). There were no significant differences in candidacy or referral status between Hispanics and whites. Among potential candidates referred to a transplant center, both American Indians (RR 0.73, 95% CI 0.51 to 0.96) and Hispanics (RR 0.68, 95% CI 0.50 to 0.88) were less likely than whites to be placed on a waiting list. Both American Indians (hazard ratio [HR] 0.37, 95% CI 0.24 to 0.58) and Hispanics (HR 0.58, 95% CI 0.39 to 0.86) were much less likely than whites to undergo renal transplantation. 

Conclusion: Despite similar referral rates for renal transplantation, American Indians and Hispanics were less likely than whites to be placed on a transplant waiting list or receive a transplant. Policies to address these disparities should address specific barriers within the transplant evaluation process.