Despite the 1972 Social Security amendments that gave end-stage renal disease (ESRD) patients financial access to treatment (dialysis and transplantation), as well as increased the total number of transplants, “not all medically suitable candidates who want a transplant can obtain one.”
This study found that “that whites and higher-income individuals disproportionately appear on transplant waiting lists nationwide,” indicating “that some differentiating factors, medical or personal, influence access early in the process.”

The investigators suggested that “personal characteristics of patients that relate to race, sex, and income” may be “influential.” For example, “possibly, blacks, females, and low-income people disproportionately prefer dialysis over transplantation for some reason.” However, as the authors state, these suggestions “verge on stereotyping.” An alternate explanation is the influence of “characteristics of the medical system” anywhere along the continuum “from education and referral of patients to their evaluation and eventual receipt of a transplant.” A third “major” possibility is that “social characteristics of patients, including their race and income, somehow affect medical judgment of suitability for transplantation somewhere in the process.” Although “conscious discrimination against specific individuals seems unlikely,” the decision made by the physician “can sometimes be subtly influenced by social factors, as all involved seek to help the ‘best’ candidates first.”