Like tens of thousands of New Yorkers with kidney disease, Adlei Scarlett lives only by the grace of dialysis, with three treatments a week to clean his blood of toxins. The only other way to keep Scarlett alive would be a kidney transplant.
“God willing, if I’m to get a kidney, I’m going to get it. That’s the way I look at it,” Scarlett said.
He may be optimistic, but in New York, not every patient has an equal chance of getting a kidney. An analysis of federal health data by NBC 4 New York's I-Team and ProPublica found patients at some dialysis centers are less likely to get organ donations than those at others.
Often times, the disparity mirrors income gaps.
At Upper East Side Dialysis Center in Manhattan, eight out of 134 eligible patients got donated kidneys in 2010.
In Crown Heights, the Central Brooklyn Dialysis Center had three transplants in a population of 188 patients.
Dialysis centers in poor and minority communities often have the worst kidney transplant outcomes. According to a study in the Journal of the American Society of Nephrology, "kidney transplantation is the preferred method of treatment" and yet "black patients were [57 percent] less likely than whites to be placed on the kidney transplant waitlist."
Dr. Jubil Malieckal, a nephrologist who works at Central Brooklyn Dialysis, said the center is working to improve health outcomes, but stressed patients in less wealthy communities often have more complex medical issues.
"I don't think that you can compare this facility to all the other facilities," Malieckal said. "I think it's the patient's mindset. We always offer each and every patient who comes in the option of going on a transplant list."
Even some dialysis patients admit they are often the ones to blame for low kidney transplant rates. Sometimes they're leery or afraid of surgery
Mercedine Samuel, who gets her treatment from Central Brooklyn Dialysis, says the center does the best it can with some very sick clients.
“You can’t blame the center when people come in the last minute and haven’t taken care of themselves and expect a miracle,” Samuel said.
Some of the under-performing dialysis centers insist transplant statistics are an unfair way to measure their quality of care. Complicated decisions about who actually gets a donated kidney are made in part by organ donation networks.
Jack Meisels, a spokesman for Gateway Dialysis in Canarsie, which had one patient transplant in 2010, said his facility actually over-performs when it comes to signing patients up for transplant wait lists.
"According to our 2011 Dialysis Facility Report, Gateway had 35 percent of our patients on a kidney transplant wait list as compared to 24 percent nationally," Meisels wrote in a statement to NBC 4 New York.
Dialysis centers that accept federal health dollars are required to offer patients a chance to sign up for a transplant wait list.
Dr. Joe Vassalotti, chief medical officer for the National Kidney Foundation, says the key to achieving more transplants is not just to offer the wait list to patients, but to teach them about organ donation and encourage them to seek transplants.
"For the health care professionals who work in a dialysis center, it's their responsibility to do the right thing and educate the patient about kidney transplant, which for many patients is the best treatment option that offers them the best quality of life and the longest life," Vassalotti said.