Following Recognition with Action

While the health and socioeconomic ramifications of the coronavirus pandemic are at the forefront of our minds, it is the senseless killings of Black individuals such as George Floyd and Breonna Taylor that have exposed the chilling consequences of systemic racism. The coronavirus pandemic disproportionally affects Black Americans across the United States, but this type of disparity is common. In fact, racial inequities exist for almost every disease state, including organ transplantation. It is the culmination of these recent events that compel reexamination of our efforts within the AST to minimize these disparities and the constellation of personal and institutional privilege that perpetuate these injustices.

Racism. Systemic racism. White privilege. These words evoke a spectrum of emotion and responses. The first two can be defined in a manner of which most AST members can agree. The third term, white privilege, is more challenging to define and does not lend itself to a straightforward definition. For an excellent article on this topic, please follow this link to Tolerance.org. For the purposes of this blog and our work over the coming year, I am going to define it the following way. White privilege is the confluence of blind spots that white Americans have when considering the world view of Black Americans, and these blind spots contribute to racial bias. This term does not diminish the work or personal sacrifice to achieve goals a white AST member has put forth. Rather, as the Tolerance.org article points out, it is the “power of normal” and the “power of the benefit of the doubt” that white Americans benefit from but Black Americans do not, and the demoralizing consequences of this reality that perpetuate the problem. In short, if advances in life are based upon merit, a white American is given a head start. This privileged head start creates opportunities for white Americans that are not equitably afforded to black Americans. Over time, these inequities compound and commonly result in dramatically different educational and income potential, as well as disparities in physical and emotional health. A stark example of this, and perhaps a blind spot for some, is how the zip code a person lives in is strongly correlated with their life expectancy.

I believe that no member of the AST thinks of him or herself as racially biased and, therefore, it can be difficult to consider the role that white privilege plays in our society and even harder to recognize it. For example, let me share a recent socioeconomic anecdote that exemplifies the inherent bias of privilege. COVID-19 hit Yale and our patients hard and exposed the inequities our patients face. Things that many take for granted such as access to safe transportation, food, and child care assistance, are by no means freely available during a pandemic. Even the ability to socially distance is not possible for everyone. Initially, all outpatient operations were shut down and during this time, parking was free. During reopening, University protocol was to only use credit or debit cards to pay for parking. This was in an effort to minimize exposure to the SARS – CoV2 virus that could occur by exchanging cash and “seemed” reasonable. One day in clinic, I was confronted with a very painful experience when two patients approached one of the transplant coordinators to say they did not have a credit or debit card to use to pay for parking. Having a bank account is something that is taken for granted. This anecdote highlights why we must learn to recognize our own individual biases and work to understand our blind spots. Moreover, a university health system creating a credit only payment system to get out of a patient-parking garage to limit the exchange of cash, while well intentioned, demonstrates the extent to which biases are institutionalized.

Racism has no place in society or in a professional society such as the AST. It is corrosive and degrades the overwhelming rewards of diversity. By not allowing everyone to achieve their potential, society at large is held back because it doesn’t benefit from the work, contributions, and perspectives of the population as a whole. I am proud to be the President of a society that has clearly stated its opposition to racism. The events of the past years leading up to this spring have increased the urgent responsibility to act. It is not enough to personally treat the people you encounter with fairness and dignity. And, it is not enough to voice your opinions only in trusted circles. While these behaviors are the foundation of a good start, more is required. To be quiet, to be inactive, to observe unjust events with disdain but do nothing, is to be complicit. Recognition without action is not acceptable. Within the practice of organ transplantation, a significant majority of our patients experience persistent racial inequities that cause disparity in opportunities, physical health, psychological wellbeing, healthcare access, quality of life, and life expectancy. As professionals in the field of transplantation, we must work together to improve the lives of our patients and colleagues. A critical part of this process is making sure that the AST is a society where everyone is valued equally, where racial bias cannot linger in the shadows, and where the blind spots of white privilege are neither tolerated nor perpetuated. The AST’s members must be able to work to their full potential to serve their patients.

The AST Board, COP leaders, and staff are committed to opposing systemic racism in all forms, eliminating racial disparities, creating a culture of racial equality, elevating collegial discourse, and holding ourselves accountable through actionable and measurable goals. The AST recently released its statement on racism, which can be seen here. Granted, a statement is not enough. While there may be personal emotional relief when one internally acknowledges issues such as implicit and unconscious racial bias, this relief is ineffective if not carried out through actions. These actions should attempt to not only mitigate personal racism and racial insensitivities, but also be the catalyst to address the impact of this privilege gap where we work, learn, and live. The AST has recognized the need for action and formed an Inclusion, Diversity, Equity, and Access (to Life) [IDEAL] task force to serve as a vehicle for change, fully integrating with the AST mission, strategy, and objectives. The Board of Directors and COP leadership have identified and recruited members to serve on this task force (the IDEAL Task Force 2020 roster).

This group cannot operate alone – they will not be effective in a silo. Your engagement and support in this initiative is critical. The Task Force will begin immediately to facilitate the initiatives already identified in the AST’s statement on racism. However, the board’s charge to them is more open-ended. While the first job is to ensure the AST is free from racial bias, they are tasked with fully reviewing our society in all aspects, to look for our biases and blind spots, and to make sure the AST is a welcoming and nurturing environment of healthcare excellence and scientific rigor for everyone. Finally, this group will lay the foundation for an AST standing committee that will be voted on by the membership for inclusion in the bylaws at next year’s ATC. This committee will be the society’s compass for the future and will endeavor to ensure that the AST is free of all forms of conscious and unconscious bias. The AST will be a professional society where all members, regardless of race, ethnicity, gender, sexual preference or gender identify, will be able to achieve their full potential. More importantly, they will feel that their achievements are celebrated. I want to encourage further exploration and consideration of other ways the society can work toward total inclusivity and cultural equity. To this end, please submit your comments and ideas in the “Add New Comment” section below.

We must follow recognition with action.

Best regards,
Richard N. Formica Jr., MD, FAST

Inclusion, Diversity, Equity, and Access to Life (IDEAL) Task Force 2020:

Marie Chisholm-Burns, PharmD, MPH, MBA
IDEAL Chair
• University of Tennessee College of Pharmacy
• Dean and Distinguished Professor

Juan Carlos Caicedo, MD
IDEAL Co-Chair
• Northwestern University
• Transplant Surgeon

Uchenna Agbim, MD, MPH
• Methodist University Hospital Transplant Institute
• Transplant Hepatologist

Kimberly Jacob Arriola, PhD, MPH
• Emory University
• Charles Howard Candler Professor of Behavioral, Social & Health Education Science

Reginald Gohh, MD
• Brown University
• Nephrologist

Elisa Gordon, PhD, MPH
• Northwestern University
• Professor, Dept Surgery-Div of Transplantation
• Ctr. for Health Services and Outcomes Research, Ctr. for Bioethics & Medical

Nicole Hayde, MD, MS
• Montefiore Medical Center
• Pediatric Nephrologist

Burnett “Beau” Kelly, Jr.. MD, MBA
Board Liaison
• DCI Donor Services, Inc.
• Surgical Director

Silas Norman, MD
• University of Michigan Medical Center
• Nephrologist

Martha Pavlakis, MD
• Beth Israel Deaconess Medical Center
• Nephrologist

James Rodrigue, PhD
Board Liaison
• Harvard Medical School
• Vice Chair of Clinical Research, BIDMC

Christina Spivey, PhD, MA, LMSW
• University of Tennessee Health Science Center
• Assoc. Professor, Dept of Clinical Pharmacy and Transplantional Science

Tilly Varughese, MD
• Rutgers New Jersey Medical School
• Infectious Disease Specialist