Dr. Gardiner’s talk about kidney transplantation and BMI was honestly shocking to me. I had no idea how prevalent renal failure is, or how much of an issue obesity is as a barrier. Yet, obesity and severe obesity continue to prohibit many individuals from receiving an organ transplant. What’s most upsetting about it is that much of this barrier to access is based on conflicting evidence. Some studies have found that obese patients (BMI 30-35) have worse transplant outcomes, but others have found that there is no significant difference. As a result, there is very little consistency in BMI-oriented policy in the 200+ transplant centers across the US. Centers often set a hard boundary for BMI limits, above which a patient is prevented from being on the waitlist. Alternatively, many centers do have flexibility on a patient-by-patient basis, but still err towards withholding transplant eligibility until patients lose weight. This means that where an obese patient goes to be evaluated for transplant determines whether or not they’re able to get a transplant, an inconsistency that should not exist. The policy regarding renal transplant and BMI criteria is arbitrary and unnecessarily limiting for obese patients–despite the fact that the Renal Association(?) now recommends that BMI not be used as a criteria for renal transplant eligibility. I found this to be pretty disturbing.
Dr. Gardiner also discussed the connection between minority status, obesity, and transplantation. There is a significant disparity in transplant rates for obese individuals, especially obese individuals of minority status. The interplay of biopsychosocial factors for ethnic minorities in the United States often puts minority populations at an especially harsh disadvantage; ethnic minorities tend to have lower socioeconomic status, poorer health literacy, worse health care access, and are more likely to be uninsured. Additionally, rates of obesity, hypertension, and diabetes are higher for ethnic minorities, particularly African Americans and Native Americans/Pacific Islander populations, which makes them much more likely to develop renal failure. Yet, despite the fact that the majority of the kidney transplant waitlist is comprised of minorities, the vast majority of individuals that receive kidney transplants are white. This indicates a serious disparity in transplant resource allocation.
All of this information points to a serious need for reconsidering renal transplant eligibility for obese and severely obese patients. The disparities in access faced by obese patients, many of whom belong to an ethnic minority, is a largely unjustified barrier based on conflicting evidence. Whether or not these policies are grounded in biases needs examination, and Dr. Gardiner made it clear how poignant these barriers to access are for many renal failure patients.