The effect of gender, race, and socioeconomic biases on the UNOS organ transplant waitlist and organ allocation

Abstract

The United Network for Organ Sharing (UNOS) is the main organ donation and distribution system in the United States. As of April 2025, there are 104,932 patients on the organ transplant waitlist (UNOS, n.d). The order in which patients fall on the waitlist is determined by more factors than just a first-come, first-served approach. It involves various medical tests and determinants in waitlist placement. However, despite these medical determinants, various disparities can be observed when it comes to one's wait time on the UNOS organ transplant waitlist. For example, when looking at gender, women face natural biological setbacks when it comes to tests that determine their placement on liver transplant waitlist. Women additionally often face setbacks while receiving a referral for organ transplantation, with physicians often influenced by social stereotypes of women and their health. In addition, there are also racial and socioeconomic biases that can be found in the UNOS waitlisting system, such as black patients being subjected to an average of one year longer on intermediate care in comparison to white patients in need of an organ transplant. Alluding to these findings, it is clear that the UNOS organ transplant waitlist system must be changed to eliminate all non-medical basis, to ensure that organs are being allocated to those who need them most, not who best fit the eyes of society.