Cleveland Holt of Evans, Georgia had been waiting for a new kidney for years when he learned from a hospital in a neighboring state that he should have been on a transplant list in 2016 instead of 2019 — a miscalculation attributed to a test that caused him and other Black patients to appear healthier than they were.
In a civil lawsuit filed last week in the U.S. Northern District Court in Atlanta, Holt has charged the national nonprofit United Network for Organ Sharing (UNOS) with using a race-based formula for those needing a transplant. The evaluation method, which is no longer in use, underestimated the severity of kidney disease in Black patients. It caused Black people to be pushed further down a transplant list and extended the time they had to wait to be matched with a kidney.
In addition to UNOS, Holt’s lawsuit also names the hospitals where he was on the waiting list for a kidney — Duke University Health System, the Medical University of South Carolina (MUSC), the Board of Trustees of the University of Alabama and Emory Healthcare.
“Making medical policy based on racial stereotypes harmed all Black Americans waiting for a kidney. This lawsuit focuses on only one of them — Mr. Cleveland Holt,” says the lawsuit filed in a federal court in northern Georgia.
Anne Paschke a spokesperson for UNOS, said in an email “We cannot comment given this is an active lawsuit.”
Duke University Health System and Emory Healthcare also said they do not comment on pending litigation.
The University of Alabama at Birmingham said in a statement: “Due to pending litigation and laws related to the privacy of medical records, we are limited in what we can say and have no comment at this time.”
Meanwhile, Emory Healthcare said in a statement the hospital system “is compliant with the current UNOS (United Network for Organ Sharing) policy, which is determined on a national level, for organ allocation.”
The Medical University of South Carolina didn’t respond to requests for comment.
For nearly four decades, UNOS has been running the country’s organ donation system. Under a contract with the federal government, the network coordinates with transplant hospitals to match candidates with donated organs.
Last year, the Biden administration announced it would seek to overhaul UNOS and break up what has been a monopoly of the federal organ transplant system. It’s part of a sweeping effort to shorten wait times, address stark racial inequities and lower the number of people who die waiting for an organ.
For Holt’s lawsuit, the issue is a once widely used test in labs and hospitals across the country. It relied on a formula that calculated results for Black and non-Black patients differently. The formula, known as “eGFR,” or estimated glomerular filtration rate, evaluates kidney function based on how quickly a waste compound called creatinine gets filtered from blood.
In 1999, the equation used to calculate eGFR was modified to adjust Black people’s results compared to everyone else’s, based on some studies with small numbers of Black patients and a now-debunked theory about race-based differences in body composition.
Since 2021, changes have been made so that the patient evaluation system is now race neutral, but they didn’t come soon enough for Holt, who faced many health woes and struggled to work because of kidney failure.
In 2021, while seeking public comments to reduce inequities and improve outcomes of organ donation, the Health and Human Services Department said that Black Americans are about four times more likely than white people, and Latinos 1.3 times more likely, to have kidney failure.
But Black and Latinos who are on dialysis are also less likely to be placed on the transplant wait list and get transplants, according to the federal government.
In Georgia, more than two-thirds of the people waiting for a kidney are Black, despite Black people representing only one-third of Georgia’s population. About a quarter of people waiting for a kidney in Georgia are white, according to the Organ Procurement and Transplantation Network.
The racial divide is not as stark nationally, where 36% of people on waiting lists for kidneys are white and 30% are Black.
Holt was first diagnosed with kidney disease in 1999, and at that time, he was able to continue working his demanding job in machine operations. He worked his way up to lead operator for the Kimberly-Clark Corporation in Georgia, spending up to twelve hours a day on the operating floor, according to the lawsuit.
As the years passed, Holt’s kidney disease worsened to the point where, in April of 2020, he began dialysis. He tried to keep working while undergoing dialysis. But his poor health forced him into early retirement in November 2022.
The average life expectancy for patients on dialysis is five to 10 years, according to the National Kidney Foundation.
Holt felt the clock ticking. His kidney disease led to other health problems including heart disease, according to the lawsuit. As he became sicker, three of the hospitals that had Holt on a waiting list removed him, saying his deteriorating health made a transplant too risky.
“He had to have hard conversations with his wife and kids about death and planning for life after he was gone,” the lawsuit said. “Tears flowed.”
Meanwhile, UNOS told hospitals to determine which Black kidney candidates could have qualified for a new kidney sooner if not for the race-based test — and to adjust those patients’ waiting time to make up for it.
Between January 2023 and mid-March, more than 14,300 Black kidney transplant candidates have had their wait times modified, by an average of two years, according to the UNOS. The change has moved them up in the line to receive a kidney
Holt was among these people and learned from MUSC that he was entitled to a four-year wait time adjustment. But even after UNOS changed course and prohibited the use of the race-based formula, the hospitals failed for more than a year to recalculate Holt’s wait time, according to the lawsuit.
Holt’s attorneys wrote that the race-based calculations used by UNOS and hospitals “ruined Mr. Holt’s life through years of delay and resulting debilitating dialysis treatments and heart surgeries, forcing Mr. Holt into early retirement. There must be serious consequences for hospitals and transplant organizations that engage in such racist discrimination.”
After eight years of delays and setbacks, Holt eventually received a donated kidney from his daughter.
Holt seeks unspecified damages for his pain and suffering, among other things, as well as interest and attorney fees.
The original story has been updated with a statement from The University of Alabama at Birmingham. The Associated Press contributed to this article.
