Understanding Social Inequality in the Kidney Transplantation System



The degree of racial inequality in transplantation outcomes is large and surprising in light of the commitment of the administrative institutions to maximizing allocative justice and to providing universal health coverage for those with kidney failure. This article adopts a sociological perspective which situates transplant candidates as participants in an allocative system with clearly defined distributive rules, while recognizing the permeation of other social institutions into this system. Taken together, the medical literature on social disparities in kidney transplantation and the social science literature on relevant processes suggest that social inequalities in kidney transplantation are produced through a combination of preexisting differences in traits made salient for inequality by the rules of the allocation system and group differences in the tendency to maximize their advantages within that system.