Health disparity uncovered in Texas kidney transplants

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by ANDY PIERROTTI / KVUE News and photojournalist DEREK RASOR

Bio | Email | Follow: @AndyP_KVUE

kvue.com

Posted on August 26, 2013 at 10:23 PM

Updated Tuesday, Jan 14 at 6:32 PM

AUSTIN -- A KVUE Defenders investigation uncovered a problem with kidney transplants in Texas so bad, Austin's transplant director calls it a public "health disparity."

In November 2012, The KVUE Defenders first told you how patients in Austin wait longer than the rest of the state for kidney transplants. We've now learned it disproportionately impacts Hispanics.

Freddie Mendoza, an Austin musician, is one of those Hispanics impacted by the disparity. He spends 12 hours a week on dialysis. Nearly seven years ago, he put himself on a kidney transplant waiting list. He's still waiting.

"In fact, when I tell people, one of the first things they ask is, 'Are you on the list? Did you get on the list?' And when I tell them yea, I've been waiting this long, they ask 'Why is it taking so long?' said Mendoza.

The disparity involves the way the government allocates kidneys to patients. More than a decade ago, the federal government divided Texas into three organ donor service areas. The region that includes Austin is called the Texas Organ Sharing Alliance. It also includes San Antonio and extends all the way to the gulf.

All three regions are supposed to have similar waiting times, but according to reports from the Scientific Registry of Transplant Recipients that's not the case. Here's why: 46 percent of kidney patients in the Houston and Fort Worth-based region get a kidney within three years. In the Dallas-based region, it's 38 percent. In and around Austin, only 13 percent get a kidney within three years of being put on the waiting list.

"The clinical consequences are truly, and very reasonably defined, is characterized as a health disparity," contends Dr. Richard Lewis, the kidney transplant director for St. David's hospital.

Dr. Lewis points out the map indirectly impacts Hispanic patients the most. That's because nearly 50 percent of all patients on the state's kidney waiting list are Hispanic. The majority of them live in Texas Organ Sharing Alliance, the region that includes Austin and San Antonio, where patients wait the longest for kidneys.

"Substantially is an understatement. Vastly longer," said Dr. Lewis. Mendoza isn't happy, "I mean, I was disgusted to be honest with you. I was upset. It was very disheartening,"

In 2010, Dr. Lewis wrote a letter to the Centers for Medicare and Medicaid Services (CMS) asking the federal agency to re-draw its map. "They have never gotten back with me," said Dr. Lewis.

CMS declined interview requests for this story. An agency spokesperson in Washington, D.C. told the KVUE Defenders over the phone it now plans to investigative Dr. Lewis' complaint.

"It seems like it's almost at a crisis situation," explained Senator Leticia Van de Putte, in reaction to our investigation. The San Antonio state lawmaker, also a pharmacist, doesn't believe it's fair to her constituents.

"It seems to me we're at a point where the policymakers don't even know what they don't know, and in this case, it is a huge disparity," said Van de Putte.

While CMS approved the most recent donor service area map, there are at least two other agencies that help set policy for kidney transplants in Texas.

The KVUE Defenders tried getting a clear answer on how the map could be re-drawn for several weeks, but were unsuccessful.

Van de Putte plans to reach out to kidney organizations and her colleagues in the statehouse who may not be aware of the situation

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