San Francisco VA Health Care System’s Dr. Cynthia Delgado named one of TIME100’s most influential people in health

TIME100 Health is a community of leaders from across industries – scientists, doctors, advocates, educators, and policy-makers, among others – dedicated to creating tangible, credible change for a healthier population. Together, they are a reminder that many things are going right, and their work is enough to inspire the belief that the world of health is in the middle of a golden age of accomplishment and transformation (https://time.com/6968909/powe-delgado/).  

Based on the efforts of a joint task force formed by the National Kidney Foundation and the American Society of Nephrology, Dr. Delgado and Dr. Neil Powe, professor at the University of California, San Francisco (UCSF) and Chief of the UCSF Department of Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, co-chaired a team to re-examine the factors used to determine an individual’s eligibility for kidney transplants and whether race should continue to be a factor. The result was the elimination of a long-standing formula that included race to help identify an individual’s place on the kidney-transplant list. 

The task force focused on that the fact that, for almost 2 decades, equations that use serum creatinine, age, sex, and race to estimate glomerular filtration rate (GFR) have included "race" as Black or non-Black. Given considerable evidence of disparities in health and health care delivery in African American communities, some regard keeping a race term in GFR equations as a practice that differentially influences access to care and kidney transplantation. Reassessment of the inclusion of race in the estimation of GFR and its implications for diagnosis and management of patients with, or at risk for, kidney diseases led to a recommendation that a unified approach without specification of race be adopted across the United States. 

Dr. Delgado’s career at San Francisco VA Health Care System (SFVAHCS) reflects a commitment to not only advancing the field of nephrology but also examining the larger issues of health equity and disparate outcomes. Dr. Delgado joined SFVAHCS’ Nephrology Section in 2011 and currently serves as the Associate Chief of Nephrology and the Director of the Dialysis Program. She has supported VA serving as Nephrology VISN 21 lead, the VCARE Dialysis oversight, and now as a member of the VA/DOD CKD Clinical Practice Guideline Workgroup. She is an internationally recognized expert on functional status, quality of life, and health disparities among individuals with chronic kidney disease. She worked as a liaison for the American Society of Nephrology with the Organ Procurement and Transplantation Network’s re-evaluation of the use of race-based estimating equations for transplant listing and donor eligibility. 

Her momentous efforts to end the racial bias in the kidney transplant algorithm will reverberate for future generations of kidney transplant recipients and has already helped change the lives of Black Americans currently dealing with kidney failure. Estimates reflect that Black patients are two to four times more likely to experience kidney failure, yet Black Americans were significantly less likely to receive kidney transplants than White patients much less be wait listed for the procedure. Since the task force’s recommendation to eliminate race in calculations of eligibility, the OPTN and the United Network for Organ Sharing (UNOS) required that U.S. hospitals with kidney transplant programs give Black patients credit for their time on the wait list thereby allowing them to receive access to transplants sooner. The implications for health care are immense and just the beginning in combating racial disparities, as Dr. Delgado shares, forcing “other organizations to re-evaluate race-based algorithms in medicine.” 

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For more information, please email V21SFCPublicAffairs@va.gov, call San Francisco VA Health Care System Public Affairs Office at 415-750-2012, or visit https://www.va.gov/san-francisco-health-care.