Rationale: Blacks with chronic illness have poorer outcomes than whites in the United States. The health outcomes of minorities with chronic obstructive pulmonary disease on the lung transplant waiting list have not been studied. Objective: To compare outcomes of black and white patients with chronic obstructive pulmonary disease after listing for lung transplantation in the United States. Methods: Retrospective cohort study of all 280 non-Hispanic black and 5,272 non-Hispanic white adults 40 years old with chronic obstructive pulmonary disease listed for lung transplantation in the United States between 1995 and 2004. Measurements and Main Results: Blacks with chronic obstructive pulmonary disease were more likely to have pulmonary hypertension, obesity, and diabetes; to lack private health insurance; and to live in poorer neighborhoods than whites. Blacks were less likely to undergo transplantation after listing compared to whites, despite adjustment for age, lung function, pulmonary hypertension, cardiovascular risk factors, insurance coverage, and poverty level (adjusted hazard ratio = 0.83, 95% confidence interval 0.70 to 0.98, p = 0.03). This was accompanied by a greater risk of dying or being removed from the list among blacks (unadjusted hazard ratio = 1.31, 95% confidence interval 1.05 to 1.63, p = 0.02). Conclusions: Following listing for lung transplantation, black patients with chronic obstructive pulmonary disease were less likely to undergo transplantation and more likely to die or be removed from the list compared to white patients. Unequal access to care may have contributed to these differences.