Racial disparities in renal transplantation in children.

Abstract

In an article in this month’s issue, Drukker et al1 from Jerusalem, Israel, are to be congratulated for writing a clear, precise, and provocative article concerning ethnic disparities in the selection of children for renal transplantation. Their article documents the remarkable finding that religious and ethnic biases do not affect access to transplantation in the midst of political upheaval. Their noteworthy article demonstrates that in Israel children are chosen for cadaveric renal transplantation regardless of ethnicity—(Israeli or Arab or religious status [Jewish, Muslim, Druse, or Christian faith]). This finding is reassuring not only to pediatric nephrologists, but to all physicians who care for children. The Jerusalem group deserves our admiration. In the discussion, the authors make a comparison between children in Israel, where there exists equal access to cadaveric kidneys for Jewish and Arab children despite a tense political situation, and children in the United States, where access for transplantation for members of minority groups has been and is problematic.2 While no direct comparison (numbers versus numbers) is made, Drukker et al cite several well-known studies of diminished access for minorities, especially blacks.2,3 Although these racial disparities are more demonstrable for adult conditions,4,5 they extend to children with renal disease.2,3 However, this type of comparison is not straightforward and the issue of access to renal allografts by children in the United States is not only complex, but requires careful examination. The article is somewhat one-dimensional when it compares the situation in Israel with the situation in the United States, where, as noted, racial disparities are documented and are a subject of intense scrutiny.2–5 This commentary is written to emphasize why such a comparison … Address correspondence to Russell W. Chesney, MD, Department of Pediatrics, University of Tennessee Health Science Center, LeBonheur Children’s Medical Center, 50 N Dunlap, Room 306, Memphis, TN 38103. E-mail: rchesney{at}utmem.edu