A Cascade of Structural Barriers Contributing to Racial Kidney Transplant Inequities

Dinushika Mohottige, Lisa M. McElroy, L. Ebony Boulware

Research output: Contribution to journalReview articlepeer-review

15 Scopus citations


Stark racial disparities in access to and receipt of kidney transplantation, especially living donor and pre-emptive transplantation, have persisted despite decades of investigation and intervention. The causes of these disparities are complex, are inter-related, and result from a cascade of structural barriers to transplantation which disproportionately impact minoritized individuals and communities. Structural barriers contributing to racial transplant inequities have been acknowledged but are often not fully explored with regard to transplant equity. We describe longstanding racial disparities in transplantation, and we discuss contributing structural barriers which occur along the transplant pathway including pretransplant health care, evaluation, referral processes, and the evaluation of transplant candidates. We also consider the role of multilevel socio-contextual influences on these processes. We believe focused efforts which apply an equity lens to key transplant processes and systems are required to achieve greater structural competency and, ultimately, racial transplant equity.

Original languageEnglish
Pages (from-to)517-527
Number of pages11
JournalAdvances in Chronic Kidney Disease
Issue number6
StatePublished - Nov 2021
Externally publishedYes


  • Equity
  • Pretransplant kidney care
  • Racial disparities
  • Structural competency
  • Transplant evaluation
  • Transplant referral


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