BackgroundReported experiences of racism in Aotearoa New Zealand are consistently associated with negative measures of health, self-rated health, life satisfaction, and reduced access to high quality healthcare with subsequent poor health outcomes. In this paper we report on perceptions and experiences of prejudice and racism by Indigenous Māori with kidney disease, their family members and donors who took part in a wider study about experiences of kidney transplantation.MethodsWe conducted semi-structured interviews with 40 Māori. Participants included those with kidney disease who had considered, were being worked up for, or who had already received a kidney transplant as well as family members and potential or previous donors. We examined the data for experiences of racism using a theoretical framework for racism on three levels: institutionalised racism, personally mediated racism, and internalised racism.ResultsWe identified subthemes at each level of racism: institutional (excluded and devalued by health system; disease stigmatisation; discriminatory body weight criteria, lack of power), personally-mediated (experiencing racial profiling; explicit racism) and internalized racism (shame and unworthiness to receive a transplant).ConclusionsThe wide-reaching experiences and perceptions of racism described by participants with kidney disease and their families in this research point to an unfair health system and suggests that racism may be contributing to kidney transplantation inequity in Aotearoa New Zealand. Addressing racism at all levels is imperative if we are to address inequitable outcomes for Māori requiring kidney transplantation.