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Invited Commentary
April 3, 2019

Barriers to Kidney Transplant—The Devil Is in the Details

Author Affiliations
  • 1Solid Organ Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
JAMA Surg. 2019;154(7):625-626. doi:10.1001/jamasurg.2019.0541

In 1984, the US Congress passed the National Transplant Organ Act to assure equitable access by patients to transplants and the allocation of donated organs among transplant centers.1 While older systems of kidney allocation were established for years, imbalances in recipients receiving kidney transplants became apparent.2 The new kidney allocation system (KAS) addressed the shortcomings of the old system by focusing on prioritizing candidates for “longevity matching,” wait-listed patients who were highly sensitized and waiting from the time of the first day of dialysis, but also by improving access for minority and underserved populations.2 The potential factors for these disparities include poverty, geography, and limited education about transplants.3,4 While progress has been made in increasing renal transplants post-KAS in African American recipients,5 disparities still exist when focusing on the wait-listing of minority groups, specifically African American individuals.6

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