Increasing Organ Donation in the African-American Community: Altruism in the Face of an Untrustworthy System

• Organ procurement
• Tissue donors
• Blacks
• Kidney transplantation
• Health services needs and demand

The shortage of transplantable organs hits the African-American community disproportionately hard. African-American persons are more likely to have end-stage renal disease and require kidney transplantation than Americans of other ethnic backgrounds. They are also less likely to receive donor kidneys. Although 35.6% of the 39 924 persons on the kidney transplant list are African-American, African-American persons account for only 21.9% of those who receive kidneys (1). Consequently, African-American persons wait a median of 39.7 months for kidney transplantation compared with 20.1 months for white Americans (2). This longer waiting time translates into higher morbidity and mortality for African-American persons with end-stage renal disease.

For reasons that are not well understood, this inequity in waiting time does not exist for liver or heart transplantations. Perhaps it could be partially explained by biological differences in organ matching—organs other than the liver do not require HLA matching. Furthermore, African-American persons are not overrepresented on the waiting lists for other organs relative to their numbers in the general population (3).

The greatest barrier to improving this situation is a shortage of organs. Small studies have reported that African-American persons decline to donate organs two to three times as often as white Americans (4). Our own study of consent to in-hospital requests for organ donation found that 47.9% of white families consented to organ donation compared with 33.3% of African-American families (Siminoff LA. African American perspectives on organ donation [Presented paper]. Fourth International Society for Organ Donation Congress. 11 July 1997; Washington, DC). Although kidneys from African-American persons are more likely to be suitable donor matches for other African-American persons, most African-American persons who have kidney transplantation receive cadaver kidneys from nonblack donors. Unfortunately, consent rates for cadaveric organ donation among all Americans are low. Fewer than 50% of families of …