What to do with race: social factors and evaluating clinical risk in kidney transplantation

America is undergoing a reckoning with race in the wake of highly publicized killings of Black people by law enforcement, political debates encircling grade school curriculum and enfranchisement, and even the proliferation of commercial genetic ancestry testing. The field of transplant nephrology is not isolated from the contention over what race is, or to what extent it should be allowed to affect outcomes. With the increasing recognition that race is a social fact (1) and on its own offers little by way of meaningful categorization of biologic difference (2,3), there is momentum to reflect on how race becomes intertwined with clinical practice and predictive modeling in transplantation (4,5). At stake in these discussions is the possibility that, by continuing to include race as a variable in predictive modeling, the field runs the risk of overemphasizing its influence and obscuring the causal pathways of genetic/biologic factors that drive the outcomes we are most concerned with—access, quality, and safety. Further, without investigation of these hidden pathways, the utilization of race may perpetuate inequities in access to transplant through the mismanagement of scarce donor organs. In the issue of Kidney360 , Chong et al. (6) evaluate the …