Several months ago, a lab technologist at Barnes-Jewish Hospital mixed the blood components of two people: Alphonso Harried, who needed a kidney, and Pat Holterman-Hommes, who hoped to give him one.
The goal was to see whether Harried’s body would instantly see Holterman-Hommes’ organ as a major threat and attack it before surgeons could finish a transplant. To do that, the technologist mixed in fluorescent tags that would glow if Harried’s immune defense forces would latch onto the donor’s cells in preparation for an attack. If, after a few hours, the machine found lots of glowing, it meant the kidney transplant would be doomed. It stayed dark: They were a match.
“I was floored,” said Harried.
Both recipient and donor were a little surprised. Harried is Black. Holterman-Hommes is white.
Could a white person donate a kidney to a Black person? Would race get in the way of their plans? Both families admitted those kinds of questions were flitting around in their heads, even though they know, deep down, that “it’s more about your blood type — and all of our blood is red,” as Holterman-Hommes put it.
Harried and Holterman-Hommes reunited in 2021 ahead of Harried’s April 2022 kidney transplant, using one of Holterman-Hommes’ kidneys. (Joe Martinez for KHN)
Scientists widely agree that race is a social construct, yet it is often conflated with biology, leaving the impression that a person’s race governs how the body functions.
“It’s not just laypeople — it’s in the medical field as well. People often conflate race with biology,” said Dr. Marva Moxey-Mims, chief of pediatric nephrology at Children’s National Hospital in Washington, D.C.
She’s not talking just about kidney medicine. Race has been used as a shorthand for how people’s bodies work for years across many fields — not out of malice but because it was based on what was considered the best science available at the time. The science was not immune to the racialized culture it sprung from, which is now being seen in a new light. For example, U.S. pediatricians recently ditched a calculation that assumed Black children were less likely to get a urinary tract infection after new research found the risk had to do with a child’s history of fevers and past infections — not race. And obstetricians removed race and ethnicity from a calculation meant to gauge a patient’s ability to have a vaginal birth after a previous cesarean section, once they determined it was based on flawed science. Still, researchers say those race-based guidelines are just a slice of those being used to assess patients, and are largely based on the assumption that how a person looks or identifies reflects their genetic makeup.
Race does have its place during a doctor’s visit, however. Medical providers who give patients culturally competent care — the act of acknowledging a patient’s heritage, beliefs, and values during treatment — often see improved patient outcomes. Culturally competent doctors understand that overt racism and microaggressions can not only cause mental distress but also that racial trauma can make a person physically sick. Race is a useful tool for identifying population-level disparities, but experts now say it is not very useful in making decisions about how to treat an individual patient.
Because using race as a medical shorthand is at best imprecise and at worst harmful, a conversation is unfolding nationally among lawmakers, scientists, and doctors who say one of the best things patients can do is ask if — and how — their race is factored into their care.
Doctors and researchers in kidney care have been active recently in reevaluating their use of race-based medical guidance.
“History is being written right now that this is not the right thing to do and that the path forward is to use race responsibly and not to do it in the way that we’ve been doing in the past,” says Dr. Nwamaka Eneanya, a nephrologist with Fresenius Medical Care, who in a previous position with the University of Pennsylvania traced in the journal Nature the history of how race — a social construct— became embedded in medicine.
The perception that there is such a thing as a “Black” or “white” kidney quietly followed patient and donor as Harried and Holterman-Hommes were on the path to the transplant — in their medical records and in the screening tests recommended.
Medical records described Harried as a “47-year-old Black or African American male” and Holterman-Hommes as a “58-year-old, married Caucasian female.” Harried does not recall ever providing his race or speaking with his physicians about the influence of race on his care, but for two years or more his classification as “Black or African American” was a factor in the equations doctors used to estimate how well his kidneys were working. As previous KHN reporting lays out, that practice — distinguishing between “Black” and “non-Black” bodies — was the norm. In fall 2021, a national committee determined race has no place in estimating kidney function, a small but significant step in revising how race is considered.
Harried and Holterman-Hommes met 20 years ago when they worked together at a nonprofit that serves youth experiencing homelessness in St. Louis. Harried resigne …