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Andrea Hassol, MSPH
Abt Associates Inc Cambridge, Mass

JAMA. 1994;271(4):269-270.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—As Gaston et al¹ point out, the hierarchical system favoring HLA matching disadvantages black renal transplant candidates. The impact of mandatory sharing of phenotypically identical kidneys is often underestimated. According to United Network for Organ Sharing (UNOS) policy, all such kidneys must be "paid back" with a kidney from the next suitable donor of the same blood type. Thus, not only is a kidney shared for a white patient (more than 90% of shared "unmismatched" kidneys are used for white patients²), it is being paid back with a kidney also more likely to be used for a white recipient. As the Table demonstrates, the races have markedly different blood-type profiles (kidneys from type O donors are used for type O recipients).

The payback policy focuses on distribution of organs among transplant centers, not among patients. Public Law 99-509 (1986) requires UNOS to acquire and allocate . . . [Full Text PDF of this Article]

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