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May 11, 1994

Racial Inequities in Kidney Transplantation: The UNOS Perspective-Reply

JAMA. 1994;271(18):1403. doi:10.1001/jama.1994.03510420034025

In Reply.  —Dr Norman misinterprets the premise of our article. Racial inequities in kidney transplantation are not perceived, but real, and waiting time is not the only aspect of the problem.1 We do not contend that HLA-based allocation is wholly responsible, only that it is a significant, relatively unacknowledged contributing factor, and that its extension to a nationwide rather than local level would be disastrous for black patients. Even the UNOS statistics presented in Norman's letter offer added support for our position: between 1987 and 1992, white recipients were at least twice as likely as black recipients to have received an extremely well-matched kidney (10, seven, or six points). We restate our support for the current six-antigen match program: it enhances graft survival and removes relatively few kidneys from the overall cadaveric pool, and despite the overwhelming racial difference in allocation of such organs, it should be retained. However,