The federal guidelines reflect a belief that better antigen matching will lead to a higher rate of kidney graft survival and that this interest in maximizing transplant outcomes should outweigh the equitable claims of patients who must wait longer for a renal allograft. Mandated antigen matching, however, also makes it difficult for black dialysis patients to qualify for the pool of scarce cadaveric kidneys. Blacks wait almost twice as long as whites for their first transplant-13.9 and 7.6 months respectively. In a given year white dialysis patients have approximately a seventy-eight percent higher chance of receiving a cadaveric transplant than black dialysis patients. Because antigens are distributed differently among racial groups, a white patient is more likely than a black patient to have antigens that match those on a kidney from a white donor.
Whites donate almost ninety percent of kidneys in the United States.
Because the proportion of blacks on the waiting list is significantly higher than the proportion of kidneys donated by blacks, white patients are more likely to have antigens that match those on donated kidneys. Thus, a disproportionately black waiting list chases a disproportionately white donor pool. Alternative allocation rules could eliminate the racial disparity in access to donated kidneys. Several scholars have argued that the best solution to racial disparity in transplantation is to increase black donation of both cadaveric and living related kidneys. They point out that blacks are less likely than whites to donate both cadaveric and living related kidneys.