This study is one of the earlier efforts to investigate racial disparities in the distribution of renal transplants. Previous studies had found racial inequalities in the acceptance of dialysis for treatment of end-stage renal failure; however, a similar trend had yet to be documented for renal transplant.

Data from government agencies reporting rates of renal transplantation and long-term dialysis were used to analyze the experience of the general population in the United States. In addition, a detailed investigation of the rates of renal transplantation was done for Renal Network 7, which includes states in the Midwest. Within this region, “there are 11 transplant staff surgeons” – of which one is a woman and none are black or Native American. Of the 60 practicing nephrologists, three are women and one is black. In the Midwestern states, the process of matching patient to organ and subsequently undertaking the procedure is in principle not susceptible to racial discrimination. “Kidneys are usually given only to patients who have a two or more antigen match with the donor. There are no set exclusion criteria, such as upper age limit, disease, or antibody titer used by any of the transplant centers. Some patients with a high cytotoxic antibody titer are offered a kidney, even if the match is less good. Once the computer match has been made, the final choice of patients is made by the residents and staff surgeon on the transplant team.”

In addition to the results reported in the abstract, the authors found that, although transplant rates are higher in the Midwest, the racial disparities are similar to those found nationally. The investigators note that “a nonwhite man between 21 and 45 years of age has less than half the chance of receiving a transplant as a white man of the same age (P<.001).” Similarly, “a nonwhite woman between 21 and 45 years of age has only two-thirds the chance of receiving a transplant as a white woman of the same age.” Furthermore, an analysis of trends over time revealed that racial inequalities persisted. In fact, comparing renal transplants performed from 1979 to 1982 to those performed from 1983 to 1985, “the number of renal transplants performed had actually decreased for nonwhite men between 21 and 45 years of age and for nonwhite women between 46 and 60 years of age.” The “only group in which the transplant percentage rose was white women between 46 and 60 years of age.”

The investigators suggest that “biological barriers” such as “differences in the distribution of tissue and blood types among races…probably account for some of the lower transplant rates in nonwhites.” However, they additionally suggest that the “observed imbalances” may “also be caused by bias.” They note that “the most favored recipient of a transplant is similar to the physicians who make the final decision: a young white man.”