Race-based kidney function formula delayed Black patients' waitlisting by 2+ years

For decades, the eGFR formula used to estimate kidney function included a 'race coefficient' that assigned Black patients a 16-21% higher kidney function score than non-Black patients with identical lab values. This meant Black patients appeared healthier on paper, so their nephrologists referred them to transplant later, and transplant centers waitlisted them later. By the time a Black patient's eGFR crossed the threshold for waitlist eligibility, their actual kidney disease was significantly more advanced than a white patient listed at the same eGFR number. Since waitlist priority accrues from listing date, Black patients who were listed late also ranked lower when organs became available. Over 14,000 Black kidney transplant candidates lost a median of 1.7 years of waiting time credit due to this formula. UNOS prohibited race-based eGFR for transplant purposes in July 2022 and retroactively restored waiting time, but the damage compounds: every year delayed on dialysis worsens cardiovascular health, reducing post-transplant survival. The formula persisted for so long because it was embedded in clinical practice guidelines as 'physiologically justified,' and challenging it required overcoming institutional inertia across nephrology, laboratory medicine, and transplant policy simultaneously.