Transplant Test Aids Hispanics
More than half of Americans waiting for kidneys are Hispanic, yet they receive one-third of transplants

February 5, 2004 (By Daniela Lamas, Miami Herald) - A shift in how kidneys are matched has made significant strides in giving Hispanics greater access to life-saving transplants, a study in today's New England Journal of Medicine reports.

Hispanics face twice the wait for kidneys as whites, in part, because they are three times more likely to have kidney failure, but kidney donations among these two groups haven't kept pace.

More than half of some 57,000 Americans waiting for kidneys are Hispanic, yet they receive slightly more than one-third of kidney transplants. Organ matches are more likely between people of the same racial and ethnic group.

''We have to increase the organ and tissue donor pool by getting minorities to understand the benefits and not fear donation as a whole,'' said Ishmael Sharpe, a manager at Life Alliance Organ Recovery Agency, which harvests organs for transplants in Southeast Florida.

A study by researchers at five institutions from California to New York analyzed easing the criteria for matching to give Hispanics a greater chance at available kidneys.

NUMBER INCREASED

The change -- adopted in May by the United Network for Organ Sharing -- has increased the number of Hispanics who received kidneys by about 7 percent, said Dr. Friedrich Port, president of the Ann Arbor-based University Renal Research and Education Association. The gain comes with a 2 percent higher rate of transplant failure.

''It does not equalize the disadvantage, but it does minimize it,'' Port said. ``What we showed is that there was a very low price for a big benefit in reducing the disadvantage of Hispanics.''

This is just a small step, say South Florida doctors and organ donation experts who are working to encourage donations in Hispanic populations and are experimenting with stronger drug regimens to prevent rejection.

Doctors at the University of Miami School of Medicine last year published their results using new immunosuppressant drugs that yielded a success rate of around 97 percent one year after kidney transplant -- even in Hispanics, who suffer higher rates of rejection. Nationally, the success rate is 88 percent in Hispanics.

RIGHT COMBINATION

''I think what we did is put the right combination together,'' said Dr. Gaetano Ciancio, a UM professor of surgery and urology.

Beyond immuno suppressants and the paucity of organs, doctors trace these problems to high blood pressure and diabetes that are disproportionate in Hispanic populations.

Untreated, these conditions can cause kidney disease, swelling dialysis clinics and organ waiting lists.

''We need much more research funding to identify the other factors that wind up with Hispanics and other minorities having such a predisposition to diabetes and heart failure,'' said Dr. Clive Callender, founder of the National Minority Organ and Tissue Transplant Education Program.

The way kidneys from deceased donors are allocated depends primarily on the length of time on the waiting list and the recipient's compatibility with the donor. Compatibility is based on blood type and genetic markers.

GENETIC MARKER

The study in today's journal analyzed whether getting rid of one of the genetic markers -- HLA-B -- would shift kidneys from whites to Hispanics, with a small cost. The researchers found that if the HLA-B match were discounted, 166 transplants that went to whites in 2000 would have gone to Hispanics instead.

This shift, while significant, just reallocates existing donor kidneys. But Port noted that more work needs to be done to ease the widespread organ shortage.

Since Callender began his education program in 1991, Hispanic rates of organ donation have nearly doubled, Callender said. Still, UM's Ciancio said he comes up against a host of misconceptions that discourage donations.

''This is like a Pandora's box,'' said Ciancio, associate director of kidney transplantation at UM. Some fear that prospective organ donors will be left to die in an emergency department by doctors who want to transplant their organs or that the organs will go only to the richest people on the waiting list.

Some waiting for a kidney spend years at dialysis units without realizing they had to register at a transplant center, Ciancio continued. Others don't even know they have dangerously high blood pressure until their kidneys have suffered.

''The solution is more education, and more prevention,'' he said.