Jim Crow and American medicine

I grew up in the American South as the end of apartheid. I remember the first Black kid who showed up in my 3rd grade and how the teacher prepared us for his arrival the day before. I remember the race riots of the ‘60s and I remember where I was when I learned MLK had been assassinated at the other end of the state.

Yes, we’ve now had a two-term Black president (although his legitimacy was questioned by many, including the current GOP candidate for President), and segregated water fountains, lunch counters and public schools are a thing of the past. But racist anachronisms still prevailed in medicine, and their consequences are seldom remediated:

“Jazmin Evans had been waiting for a new kidney for four years when her hospital revealed shocking news: She should have been put on the transplant list in 2015 instead of 2019 — and a racially biased organ test was to blame.

“As upsetting as that notification was, it also was part of an unprecedented move to mitigate the racial inequity. Evans is among more than 14,000 Black kidney transplant candidates so far given credit for lost waiting time, moving them up the priority list for their transplant.

“I remember just reading that letter over and over again,” said Evans, 29, of Philadelphia, who shared the notice in a TikTok video to educate other patients. “How could this happen?”


“Pavlakis calls what happened next an attempt at restorative justice: The transplant network gave hospitals a year to uncover which Black kidney candidates could have qualified for a new kidney sooner if not for the race-based test — and adjust their waiting time to make up for it. That lookback continues for each newly listed Black patient to see if they, too, should have been referred sooner.

“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 United Network for Organ Sharing, which runs the transplant system. So far more than 2,800 of them, including Evans, have received a transplant.”


“Change is beginning, slowly. No longer are obstetricians supposed to include race in determining the risk of a pregnant woman attempting vaginal birth after a prior C-section. The American Heart Association just removed race from a commonly used calculator of people’s heart disease risk. The American Thoracic Society has urged replacing race-based lung function evaluation.

“The kidney saga is unique because of the effort to remedy a past wrong.”

Restorative justice in medicine