Correlates of support for living donation among African American adults.

The number of patients who are in need of a life-saving transplant continues to grow at an alarming rate, and the gap between this need and the number of available organs is widening steadily. Not only is this disparity the No. 1 problem in transplantation today, but it is also particularly pronounced within the African American population.1 In the state of Georgia, the median wait time for kidney transplantation is 1151 days for African Americans as opposed to 767 days for white patients. Even though African Americans comprise the majority of persons on the kidney waiting list (63%), they represent less than half of kidney transplant recipients.2 The need for transplantation among African Americans is exceptionally high and is exacerbated by the low organ and tissue donation rates in Georgia and throughout the United States. Deceased donations account for more than 88% of transplants, whereas living donation rates remain markedly lower (11.5%).2 Of the 106 living donor transplants performed in Georgia in 2007, less than one-third (30) were to African American recipients. The benefits of living donor transplantation, especially for patients with renal failure, are well documented. 3–6 Compared with deceased donor transplantation, living donation is more cost-efficient and results in lower rates of acute rejection, improved graft survival, and enhanced long-term functioning.7–9 For patients with end-stage renal failure, a living kidney donor transplant can result in relief from the burden of dialysis and improved survival rates; 50% of living kidney donations are still functioning after 20 years versus the 10-year mean survival of deceased donor organs.10 However, the great challenge of living donation is that it requires a second, healthy person to undergo the donation surgery in order for the patient to receive a functioning organ.9,11–14 Living donors can be blood relatives or unrelated individuals and can donate an entire organ, such as a kidney, or a segment of an organ, such as a lobe of a lung or segment of a liver or pancreas. In the African American community, pre-existing health conditions such as diabetes, hypertension, and kidney disease are prevalent.15,16 African Americans represent 13% of the general population but more than one-third of those with renal disease.17 They are 7 times more likely than whites to have hypertension, 4 times more likely to be on dialysis,1 and have consistently higher rates of heart disease and cancer.18,19 The possibility of living donation for African Americans has been thwarted by the presence of these health issues and others such as pancreas, bladder, or liver problems, unsuitable creatinine clearance, hepatitis, and high body mass indexes, all of which render potential living donors unsuitable.20–22 Healthy potential African American living donors who do not have any of these ailments may still be unable to donate because of immunological incompatibilities with their potential recipient, such as a mismatch of ABO blood group or human leukocyte antigens, which are essential in the matching process. Because of the lack of available donors, many African Americans live and die on dialysis; moreover, they do not have access to or do not choose to pursue transplantation.9,23,24 Much of this situation has to do with the patient’s willingness to approach a loved one and accept his or her offer of an organ.8,25,26 Murray et al12 reported that 60% of 115 patients from a dialysis clinic never talked with anyone about the possibility of living donation, and 80% actually refused to consider a transplant from a family member. Other researchers8,23,25,27 have similarly reported that many patients refuse to have potential matching donors evaluated and are not willing to actively pursue living donation as a treatment option. Numerous patients choose to continue dialysis because of concerns about harming the potential donor, possible resentment after donation, graft rejection, and feelings of indebtedness to the donor.8,9,25,27 As a result, patients who could potentially receive living donor transplants experience significantly diminished quality of life, may wait many years for a deceased donor’s organ to become available, and could die before receiving a lifesaving organ.28 Despite the disproportionate need among African Americans for transplants, living donation is a topic that is infrequently discussed and greatly understudied within that population.8,11,14,29–37 African Americans should be taught about what it means to be a living donor, the evaluation process, and what to expect after donation, and they need to hear stories about the experiences of donors and their recipients.11,38–40 Such awareness and education could potentially benefit friends and family members who are currently on dialysis. It could make people more receptive to the idea of transplantation when and if they are approached by friends and family members who are on dialysis. It could also increase the likelihood that friends and family members would approach their loved ones who are on dialysis about the possibility of living donation when the dialysis patient is unaware or unwilling to consider this option. However, before designing educational materials for African Americans, one must understand their knowledge, attitudes, and beliefs surrounding the topic of living donation. The purpose of the current study is to shed light on this issue by exploring the correlates of likelihood of becoming a living donor among community-recruited African American parishioners. Demographic characteristics, donation-related knowledge, and personal experiences are examined in relation to intentions with respect to living donation.