The Causes of Racial Inequalities in Kidney Transplantation

Jonathan Daw, University of North Carolina at Chapel Hill

Large racial inequalities in kidney transplantation pose an empirical and theoretical puzzle. White transplant candidates are about twice as likely to obtain a kidney transplant as are black candidates. Yet all patients with end-stage renal disease are eligible for Medicare coverage, and racial discrimination does not appear to play a major role for patients on the kidney transplantation waitlist. Using data on all kidney donors and transplant recipients in the U.S. since 1987, results show that these inequalities result from a complex process combining residential stratification, blood type and other biological differences, and the probability of obtaining a living donor from one’s family and friendship networks. Finally, future research using counterfactual microsimulation techniques is described.