LAUSR

All patients deserve equal access to lifesaving End Stage Renal Disease treatments. The US donation and transplantation system must recognize and eliminate systemic racism to ensure Black Americans’ (hereafter also called Blacks) equal access to kidney transplantation and organ donation. In population percentage, Blacks are overrepresented on the waitlist and disproportionately captive to dialysis. Black Americans access transplantation will be harmed by both the new kidney allocation system as well as industry resistance to engaging around organ procurement organization (OPO) reform and the new CMS rule on OPO performance. In many ways, systemic racism and structural racism are synonymous and used interchangeably. Structural racism is defined as the social forces, institutions, ideologies, and processes that interact with one another to generate and reinforce inequities among racial and ethnic groups. The term structural racism emphasizes the most influential socioecologic levels at which racism may affect racial and ethnic health inequities. Structural mechanisms do not require the actions or intent of individuals. A discussion of specific inequities related to HLA matching, OPO performance metrics, and sharing of deceased donor kidneys across donor service areas (DSAs) follow.