COVID-19; Medical Ventilators; Triage Protocol; Health Equity; Black, Indigenous, & People of Color; Kidney Transplants Disparities


Bioethics and Medical Ethics | Community Health and Preventive Medicine | Medicine and Health | Politics and Social Change | Public Health | Public Health Education and Promotion | Quantitative, Qualitative, Comparative, and Historical Methodologies | Race and Ethnicity


Introduction: Since the COVID-19 pandemic in the United States, Black, and Latinx populations have been disproportionately affected by the COVID-19 pandemic. It can be inferred with high confidence that those most vulnerable are the least likely to receive essential care. Kidney transplant allocation and COVID-19 triage protocols share commonalities in that both protocols involve using multivariate scored criteria with objective and subjective inputs. As such, the similar conclusion in outcomes is concerning. It is worth questioning whether the racial inequalities demonstrated in the COVID-19 pandemic related to access to life-saving ventilators were associated with triage protocols.

Methodology: Using an exploratory comparative analysis method, the prevailing medical ventilator triage protocol was compared to the Sequential Organ Failure Assessment (SOFA) score-based kidney transplant recipient allocation protocol. The analysis explores the extent to which medical ventilator triaging protocols that contributed to racially biased outcomes were the result of the adoption of racially biased SOFA scoring.

Discussion: The exploratory comparative analysis of current medical ventilator triage protocols reveals that existing ventilator triage protocols were developed based on SOFA scoring systems. Similar to the racial disparities found in access and allocation of kidney transplants as a result of SOFA scoring, adverse patient outcomes during the COVID-19 pandemic can be considered the result of racially biased medical ventilator triage protocols. These outcomes strongly point to the belief that patients of color were the least likely to get a life-saving ventilator.

Conclusion: The kidney transplant protocol is a resource-dependent model for medical supply shortages like a global pandemic. Specifically, the comparative analysis reveals that scoring-based systems used in triage protocols are biased for and against different populations. Black and Latinx individuals were found to be the least likely to obtain access to life-saving ventilator therapy when compared to all racial groups in the US when scoring protocols were used to triage.