Racial differences in kidney transplantation have received recent attention both in the medical community and in the general public. Most efforts to improve renal transplantation among minority groups have been directed toward cadaveric donation and transplantation. Since evaluation of the comparative trends by race of living related donor (LRD) kidney transplantation have been lacking, we examined trends of LRD transplantation from 1983 through 1990 using national data from the US Renal Data System. The total number of LRDs in blacks did not change during the 8-year period between 1983 and 1990 (198 in 1983 and 197 in 1990). During this same period, the total number of LRDs in whites increased by 11% (1,390 in 1983 and 1,548 in 1990). Rates of LRD transplantation per nontransplanted dialysis patients were consistently lower in blacks and females compared with whites and males, respectively. White males have a fivefold higher rate of LRD transplantation than black males, whereas white females have a fourfold higher rate then black females. When intraracial gender differences were examined, black males were transplanted with LRD kidneys at a rate 20% higher than black females. This difference was present between 1983 and 1989, but was nonexistent in 1990. Among whites, males also had a higher rate of LRD transplantation than females, which gradually decreased from 34% in 1983 to 20% in 1990. In view of the ever-increasing demand for cadaver organs, additional effort in the medical community and society toward increasing LRD transplantation rates represents a more promising approach to increasing organ donation in all groups than a single focus on cadaveric donation.(ABSTRACT TRUNCATED AT 250 WORDS)