is decedent race an independent predictor of organ donor consent or merely a surrogate marker of socioeconomic status background studies have demonstrated that african american race is a strong predictor of nondonation however it is often and correctly argued that african american race is a crude explanatory variable that is a surrogate marker of socioeconomic status education and access to health care we hypothesized that when controlling for these factors african american race would cease to be a predictor of organ donationmethods a retrospective review of 1292 alabama decedents who were approached for organ donation between 2006 and 2009 was performed multivariable logistic regression models were constructed to identify the most parsimonious model that could explain the variation in the log odds of obtaining consentresults consent for donation was obtained from 49 of the decedents families household income was a predictor of organ donor consent only in whites surprisingly household income was not statistically different between consented and nonconsented african american decedents us 25147 vs us 26137 p090 on multivariable analysis education urban residence and shorter distance between the decedents residence and donor hospital were significantly associated with obtaining consent for organ donation on univariate analysis the odds ratio of donor consent in whites compared with african americans was 276 95 confidence interval 217357 when controlling for socioeconomic status and access to health care variables the odds ratio of donor consent increased to 436 95 confidence interval 288661conclusions we interpret this result to indicate that there remains unknown but important factors associated with both race and obtaining organ donor consent further studies are required to isolate and determine whether this factors is modifiable