A comprehensive study of over 500,000 patients reveals that living in a disadvantaged neighborhood significantly reduces a person's chance of receiving a life-saving kidney transplant PMID:41468017. The research highlights that where a person lives—accounting for poverty, housing instability, and local unemployment—is as much a predictor of transplant access as their medical condition, with the steepest barriers faced by minority candidates in high-deprivation areas. ### Key Findings This retrospective cohort study analyzed data from over 500,000 adults with end-stage kidney disease and about 100,000 transplant candidates between 2015 and 2021. The results were consistent across various types of transplant access: - **Waitlist Access:** For every 100 people in affluent neighborhoods who were placed on the transplant waitlist, only 71 people in disadvantaged neighborhoods achieved the same status. - **Transplant Rates:** Among those already on the waitlist, for every 100 candidates in affluent areas who received a kidney, only about 89 in disadvantaged areas did. - **Living Donors:** For every 100 living donor transplants received by patients in low-disadvantage areas, only 65 patients in high-disadvantage areas received one. - **Early (Preemptive) Transplantation:** For every 100 patients in affluent areas who received a transplant before needing dialysis, only about 62 in disadvantaged areas were able to bypass dialysis. - **Racial Disparities:** The impact was most severe for Black candidates in disadvantaged neighborhoods. For every 100 white patients in affluent areas who received a living donor transplant, only about 23 Black patients in disadvantaged areas received one. ### The Medical Context Kidney failure affects more than 800,000 people in the United States PMID:40199386. While kidney transplantation is the standard of care—offering better survival and quality of life than dialysis—only about 14 out of 100 patients on dialysis are currently waitlisted for the procedure PMID:32434512. Neighborhood-level factors, such as poverty and education, are increasingly recognized as independent predictors of health that create a "cascade" of structural barriers PMID:35367020,PMID:38973768. For example, residing in segregated or marginalized communities has been linked to an 8 out of 100 lower likelihood of even being referred for an initial transplant evaluation PMID:39186375. Even after national policy changes in 2014 aimed at increasing equity, geographic and socioeconomic factors continue to determine who receives the best-matched organs PMID:39430573. ### Clinical Takeaway For patients and healthcare providers, this data shifts the focus from individual medical eligibility to environmental and structural hurdles. - **For Patients:** If you live in an area with limited transportation or high poverty, it is vital to engage with transplant social workers early in the process. They can assist in navigating financial support systems and transportation programs that may be available but underutilized. - **For Health Systems:** The use of objective measures, like the Area Deprivation Index, should be integrated into clinical workflows. Clinics and transplant centers are encouraged to implement community-based outreach and financial support initiatives specifically targeted at neighborhoods identified as high-risk to ensure that zip codes do not dictate life expectancy. ### Caveats This was an observational study, meaning it can show a strong link between neighborhood disadvantage and transplant access, but it cannot definitively prove that the neighborhood caused the disparity. Other unmeasured factors, such as individual health behaviors or center-specific clinical protocols, may also play a role. ### Citations 1. PMID: 41468017 2. PMID: 40199386 3. PMID: 32434512 4. PMID: 35367020 5. PMID: 38973768 6. PMID: 39186375 7. PMID: 39430573