The Volokh Conspiracy

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Organ transplants

Race and Kidney Transplants—A Brief Rejoinder to Dr. Stanley Goldfarb

My brief rejoinder to his response to my earlier post on this subject.


In my last post, I put up a reply by Dr. Stanley Goldfarb to a piece I a post on "Race, 'Wokeness,' and Kidney Transplant Shortages," which was in part a critique of Dr. Stanley Goldfarb's article on the same subject, published by the City Journal. In this post, I offer a brief rejoinder to Dr. Goldfarb.

In his response, Dr. Goldfarb write that he does not  support "a race-based formula for determining kidney function," which in turn would affect prioritization for kidney transplants. Rather, he says he merely rejects claims that the race-based formula recently replaced by the Organ Procurement and Transplantation Network (OPTN) and the United Network for Organ Sharing (UNOS), was racist, because it disadvantaged African-Americans. He also object to the retroactive application of the new, race-neutral formula to patients already on the transplant waitlist.

I appreciate Dr. Goldfarb's clarification of his views. However, it seems to me that, in his original article, he did in fact object to the displacement of the old race-conscious formula. Indeed, he described it (along with another policy change) as "perhaps the most dangerous victory for wokeness in health care to date." Even in his reply, he continues to support the use of the race-based system for patients already on the waitlist. At the very least, his position strikes me as far from an unequivocal rejection of racial discrimination.

As noted in my previous post, the use of racial criteria here can perhaps be defended on the ground that this is one of the very rare cases where  there are genuinely significant physical differences between racial and ethnic groups that affect their chances of a successful transplant. But, as also noted there, such an argument at least requires strong evidence that there is no other comparably accurate way to assess patients. In addition, as discussed in my earlier piece, racial discrimination is particularly indefensible in a situation where we can easily eliminate kidney shortages for patients of all races, simply by legalizing organ markets.

While Dr. Goldfarb and I may continue to differ on the issue of racial discrimination, there are some points of agreement between us, as well,  also covered in my previous piece. For example, we agree it would be a mistake to reduce the priority given to kidney donors in the waitlist, in order to promote racial "equity."