This news hints at an interesting revelation. A study from Georgetown University Medical Center claims that physician bias might be the cause why African Americans have apparently not been given kidney/pancreas transplants at the same rate as compared to similar patients in different racial groups.
Medicare coverage for people requiring an immediate kidney/pancreas transplant have supposedly augmented in the past decade. In July 1999 Medicare made the alterations as a deliberate endeavor by the government planned to deal with racial and economic inequalities that were present. But increased Medicare dollars have apparently not turned into more access for African Americans or Hispanics.
Keith Melancon, MD, director of kidney and pancreas transplantation at Georgetown University Hospital and associate professor of surgery at Georgetown University Medical Center, and colleagues investigated this occurrence.
Melancon, commented, “Our research raised the possibility of racial bias on the part of physicians who might incorrectly assume that African Americans are type 2 diabetics when in fact, they would metabolically meet the criteria for type 1 diabetes. Since this is a transplant that is most often performed in type 1 diabetics, their doctors might not even raise the possibility with their black patients. Also, health care providers might incorrectly predict worse outcomes for black patients, despite research that shows they do about as well as other racial groups.”
For the study, Melancon’s group observed the national transplant list prior to and post Medicare changes in July 1999. Of the patients already scheduled for transplant, the odds of African Americans were about 27% less to be suggested for a kidney pancreas transplant as opposed to Caucasians. It was seen that the chances of Hispanics were 25% less to be recommended. Following the Medicare changes, it was noted that African Americans had 28% less chances to be suggested for kidney/pancreas transplant and the odds of Hispanics were roughly 31% less to be recommended.
Melancon stated, “So, the situation for African Americans and Hispanics actually got worse instead of better.”
One of the advantages of a kidney pancreas transplant is that there appears to be a better probability of a match as the list is much shorter i.e. 2200 as opposed to over 80,000 for a kidney alone, as per the United Network of Organ Sharing (www.unos.org). Patient survival and kidney graft survival seems to be superior in kidney pancreas transplants.
Melancon remarked, “I don’t think the medical community has been aggressive enough about kidney/pancreas transplant, especially in African Americans who are assumed to have type 2 diabetes. When a person has type 2 diabetes and they are obese, the benefit of a kidney/pancreas transplant is often outweighed by the risks of surgery which are higher in an obese person. So they are not offered the transplant. There is also a population of people with diabetes who are sort of between type 1 and type 2. This procedure would work for them too. But I think the medical community is, in some cases, making assumptions about the African American and Hispanic population that they are not making with other racial groups.”
A kidney/pancreas transplant appears to be the only present, dependable technique to provide diabetics normal glucose and insulin levels 24 hours a day. It is not a cure, but apparently it does get rid of the medical issues related to diabetes.
This study was published in the November issue of the American Journal of Transplantation.