As one of the leading causes of death in the U.S., kidney disease is a serious public health problem. The disease is particularly severe among Black Americans, who are three times more likely than white Americans to develop kidney failure.

While Black people constitute only 12% of the U.S. population, they account for 35% of those with kidney failure. The reason is due in part to the prevalence of diabetes and high blood pressure – the two largest contributors to kidney disease – in the Black community.

Almost 100,000 people in the U.S. are awaiting kidney transplantation. Though Black Americans are more likely to need transplants, they are also less likely to receive them.

Making matters worse, kidneys from Black donors in the U.S. are more likely to be thrown away as a result of a flawed system that erroneously considers all Black donor kidneys as more likely to stop working after a transplant than kidneys from donors of other races.

As a scholar of bioethics, health and philosophy, I believe this flawed system raises serious ethical concerns about justice, fairness and good stewardship of a scarce resource – kidneys.

The U.S. organ transplantation system rates donor kidneys using the kidney donor profile index, an algorithm that includes 10 factors, including the donor’s age, height, weight and history of hypertension and diabetes.

Another factor in the algorithm is race.

Research on previous transplants shows that some kidneys donated by Black people are more likely to stop working sooner after transplantation than kidneys donated by people from other races.

This brings down the average time a transplanted kidney from a Black donor can last for a patient.

As a result, kidneys donated by Black people are discarded at higher rates because the algorithm downgrades their quality based on the donor’s race.

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