We calculated the chance of receiving a kidney transplant in the United States in 1983, and in the Midwest from 1979 through 1985, considering age, sex, and race. In the United States, 23,026 patients began long-term dialysis and 6112 (27%) received a kidney transplant. Transplant rates were 31% for men and 21% for women. White patients had a 30% rate and nonwhite patients a 20% rate. Patients less than 11 to 35 years old had an 85% rate vs a 3% rate for those older than 56 years. When race, age, and sex were analyzed together, nonwhite patients aged 21 to 45 years had only half the chance of receiving a transplant compared with white patients of the same age and sex. Women aged 46 to 60 years had less than half the chance of receiving a transplant when compared with men of the same age and race. These data show that there are age, sex, and race imbalances in the distribution of renal transplantation. We believe these imbalances only partially have a morally neutral biological, medical, social, and cultural explanation and that there should be a fairer distribution of kidney transplants.