It has been suggested that areas with large inner-city Black and Latino populations have worse organ donation rates than those with large suburban and rural White populations. Yet data are sparse. We studied family refusal rates (FRRs) to cadaver organ donation between 1/84 and 5/87 in three United States city-areas (New York, Los Angeles, and Miami) with large Black and distinct Latino populations. Blacks are at least 18% and Latinos at least 25% of the combined general population of the three cities, totaling over three and four million people, respectively. In addition, Blacks and Latinos represent 42% of cadaver transplant recipients, 49% of patients on waiting lists, and 57% of the patients on dialysis in the three cities. Combining the data from the three cities, Black (45%) and Latino (43%) FRRs were similar (P =.78), and each was significantly higher than that in the White population (17%) (Pc.OOOl). The overall refusal rate in NYC (42%) was significantly higher (P<.0001) than in LA (26%) or Miami (21%), and LA’s refusal rate was significantly higher than Miami (P =.03). The refusal rates for the White (31%) and Black (55%) populations in NYC were each significantly higher than their respective populations in LA (14% and 33%) or Miami (11% and 36%) (Pc.O5). Although Miami Latinos had a lower FRR (35%) than Latinos in NYC (46%) or LA (45%), the difference was not statistically significant (P =.19 and P =.20, respectively). In the three cities combined, 515 of a possible 1772 medically and legally eligible organ donors were lost during the 40 months studied due to families’ refusal of consent. This represents approximately 1000 transplantable kidneys and large numbers of extrarenal organs. Further studies are needed to elucidate the reasons for differences in donation rate among groups and regions in the United States.