Leveling-up versus leveling-down to address health disparities in transplantation.

Racial inequity in access to kidney transplantation continues to be an area of focus. Rightly so, as deceased donor organs represent a scarce resource and disparities in access require attention. In this month's AJT, Reese et al. provide insights into the disparate allocation of preemptive deceased donor kidneys, show why Blacks have lower rates of preemptive transplants, and propose interventions that are targeted at reducing this disparity (1). One important aspect of this work is the focus on listing criteria that currently requires only a single test of eGFR ≤20 ml/min/1.73m2 . Here, the authors have struck on a fundamental issue which has been the cornerstone of waitlist eligibility yet is flawed in its lack of incorporating greater measures of medical urgency.