Heather Gardiner’s talk regarding patient eligibility for kidney transplants raised questions about using BMI as surgery criteria and challenged disparities in transplant access. Minorities are disproportionately effected by kidney disease, largely because of greater risk for diabetes and hypertension, with American Indians 9.5 times more likely than Caucasian individuals to develop kidney failure. Although frequently used in the US, hemodialysis is a time-intensive and arduous treatment, so transplants are preferred treatment for kidney disease, yet it is difficult to obtain a transplant, especially for non-white patients. In addition to this, BMI is often used as criteria for transplant eligibility, despite the fact that studies on short-term success of transplants in obese patients are contested and long-term studies show good outcomes, suggesting obesity may not be a significant surgery risk factor. As well, using obesity as criteria compounds minority inaccess to transplants, due to higher obesity rates in disadvantaged populations. Using obesity as criteria also creates barriers to treatment as it is unrealistic to ask low-energy and ill patients to lose weight after undergoing dialysis, and once individuals are moved to inactive status on the transplant waiting list, the status of only about half later changes. Interestingly, Gardiner described one study in which treatment center professionals were interviewed about performing transplant surgery on obese patients and participants described a wide range of beliefs about an appropriate BMI cutoff, with many unsure or feeling the decision would be contextual. Gardiner also described a study of 19 kidney treatment center policies, with the finding that respondants desired a higher BMI cutoff and believed in a more holistic assessment of patients.
Gardiner’s talk was relevant to our class’s exploration of health disparities and exemplified how health illiteracy and low SES causes minority populations to inordinately struggle with disease. As well, Gardiner’s speech exemplified lack of transparency in the healthcare system, as many patients are unaware of a kidney center’s policies before joining and later cannot switch, and hemodialysis has many drawbacks but is likely used partly for its profitability. Finally, Gardiner’s talk exemplified the role of community and lifestyle in disease prevention, as increased rates of kidney disease in minority populations largely result from inaccess to healthy foods, exercise and information.
I agree with Gardiner’s point that there are more accurate forms of measuring adipose tissue than BMI, and I think more research needs to be done about the outcome of surgery for obese patients to determine if adipose tissue should be a consideration for surgery at all, as current information is somewhat mixed. If more research shows adipose tissue is not a high-risk factor for surgery, it will be difficult to change BMI requirements, particularly due to lack of transparency about center policies. Possible solutions might include government requirement of increased transparency, allowing patients to begin treatment only at centers that do not have BMI requirements. As well, more research may convince professionals the requirement is unecessary, increasing the number of centers that perform transplant surgery on high-BMI patients.