*Purpose: The Australian deceased donor (DD) kidney transplant program places a large emphasis on HLA matching despite a known disadvantage to ethnic minority groups. We assessed the clinical outcomes of deceased donor kidney transplants in Australia, and the impact of the current allocation policy on racial minority groups.

*Methods: A retrospective cohort analysis of adult DD kidney transplants from 2000-2018 was conducted using prospectively collected ANZDATA records. Transplants were divided into “Matched” or “Waitlist” allocation groups based on the OrganMatch score, the transplant state, and the current national and state-based allocation algorithms in use in Australia.

*Results: Of the 7440 transplant events, 40% were Matched transplants. Matched transplants had a small benefit in renal function (67 vs 64mL/min/1.73m2 at 1 year; 66 vs 62 at 10 years), lower incidence of rejection (23% vs 30%, p<0.001), longer graft survival (median 5.5 vs 4.5 years, p<0.001), and longer patient survival (HR 0.89 (0.78, 1.01), p=0.07) compared to waitlist transplants. A higher proportion of Caucasian (2566/5631, 45%) compared to Aboriginal and Torres Strait Islander (56/309, 18%) recipients received a Matched transplant. Dialysis time was significantly shorter for Matched transplants (28.1 vs 44.8 months, p<0.0001), and contributed significantly to the benefit seen in graft and patient survival in Matched transplants.

*Conclusions: Deceased donor kidney transplants which are well-matched continue to out-perform transplants which are poorly matched, however a significant component of this benefit is via decreased time on dialysis. Ethnic minority groups are less likely to receive a well-matched kidney, spend longer on dialysis, and are disadvantaged by the current allocation model.

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