Social inequalities in the kidney transplantation system

Although transplantation is not a traditional topic of sociological research, these realms of inquiry have much to offer each other. This dissertation 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.;Chapter 1 provides an introduction to research on social disparities in the kidney transplantation system, and is intended to introduce non-specialists to this topic.;Chapter 2 investigates the determinants of racial inequalities in kidney transplantation outcomes. Using administrative data, this analysis finds that racial inequalities in this system are primarily the result of differences in living donor kidney transplants, geographic residency, and the distribution of immunologically important genes. Because these inequalities are largely rooted outside the institutional confines of the kidney transplantation system, these findings illustrate the difficulty of constructing a race-neutral institution in a racially stratified society.;Chapter 3 adopts a similar research design to investigate socioeconomic inequalities in kidney transplantation. Educational attainment is linked to transplant outcomes primarily through the type of transplants obtained. Higher educated candidates are advantaged by their higher rates of living donor kidney transplantation and higher probability of genetic compatibility with deceased donors, whereas lower educated persons are advantaged by their places of residence and the dynamics of immunological crossmatching.;Chapter 4 uses data on the attributes of the kidney transplant waiting list and population data on the distribution of biologically-informed kinship ties and health statuses to investigate the likely distribution of suitable living donors within the kinship networks of persons on the kidney transplant waiting list. The results suggest that blackwhite disparities in living donor kidney transplantation are not the result of group differences in the availability of suitable donors in their kinship networks. Given the sparse number of potential donors most transplant candidates have evaluated, however, it is likely that the higher probability that white kin are suitable donors is a major determinant of racial differences in living donor kidney transplantation rates.;Chapter 5 concludes the dissertation by discussing the primary themes of this research.