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January 26, 1994

Race and Allocation of Kidneys for Transplantation

JAMA. 1994;271(4):270. doi:10.1001/jama.1994.03510280031017

To the Editor.  —I find the article by Gaston et al1 disturbing. The encroachment of specific racial issues into transplantation medicine seems to disqualify the scientific method and violate the art of medicine.The argument in favor of injecting race bias into kidney allocation seems to hinge on two premises, one spoken and one not. The overt premise is that with modern immunotherapy, HLA matching is no longer predictive of graft survival. The covert premise is that such immunotherapy represents an acceptable therapy from a formal risk vs benefit perspective. If, in fact, both of these are true, then we are witnessing a technological triumph in renal transplantation that would obviate any specific racial reference and allow the formulation of a new race-blind protocol for allocation of scarce organs.Until that time, the race-correlated but prejudice-free technique of HLA matching to enhance graft survival represents the state of the

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