Kidney Blogging, Cont'd: Special MLK Edition

Kidney disease, which is often associated with diabetes, is an epidemic among black Americans. "We all know someone who needs kidneys," the Rev. Nelson "Fuzzy" Thompson, a local civil-rights activist, told Kansas City Star columnist Steve Penn after Thompson received a kidney from his goddaughter. He didn't say "we black people," but it's clear that's what he meant; relatively few white people know someone who needs kidneys, which may be one reason the system is so hard to reform. African Americans make up a third of the nearly 70,000 Americans on the waiting list for cadaver kidneys, even though they are less likely to be put on the transplant list than whites with kidney disease. (The reasons for the disparity are disputed.) Columnist Penn, whose brother received a kidney transplant, has used his column to encourage more blacks to become donors.

As legal scholar Michele Goodwin points out in her book Black Markets: The Supply and Demand of Body Parts, opponents of incentives for organ donors often treat blacks only as potential victims of markets and never as beneficiaries--even though they would likely benefit most. And the ideology that says that the families of deceased donors should have no say over who gets their loved ones' organs discourages blacks to donate. Distrustful of the medical system for historical reasons Goodwin documents--Did you know that southern medical schools used to be known for teaching anatomy better than northern ones, because their suppliers could easily rob black graves to get cadavers?--many blacks indicate that they would be more likely to donate organs if they could be sure the parts would go to other blacks. That idea would horrify many ethicists, who hate the idea of race-conscious organ allocation, but it would benefit everyone on that humongous waiting list.

Meanwhile, as the NYT's Richard Pérez-Peña reports there are 350,000 Americans on dialysis, and those in New York State tend to fare worse than others. In an article that could have been headlined, "Anti-Corporate Bigotry Hurts Poor, Sick Blacks," he reports:

At New York dialysis centers, those being treated are more likely to suffer from anemia and are less likely to have enough impurities and excess fluid removed from their blood, allowing more damage to their bodies, according to the records.

Experts say the disparity is caused in part by the fact that New York is dominated by small dialysis providers, many of them run by people with little background in medicine who entered the business to meet the surging demand.

Many of the smaller centers provide good care, experts say, but a lot also lack the money and staff training to compete on a quality-of-care basis with the national dialysis chains that dominate the market across the rest of the country.

Newly released patient data show that people who receive their dialysis from a national chain generally fare better than those treated by an independent provider.

But the chains are largely blocked from operating in New York by a state law that effectively bars publicly traded companies from owning health care facilities in the state.

In a system that is terribly difficult to reform, fixing that law should be relatively simple--if only the beneficiaries weren't too sick and weak to campaign for reform.

Posted by Virginia Postrel on January 15, 2007