Confronting the Crisis: Organ Transplantation in the African American Community (2008)

Organ and tissue transplantation is increasingly successful as biomedicine and surgical techniques have advanced and multiplied since the 1960s. Recent televised appeals for organ and bone marrow donation have increased the public's awareness of these advances. Survival rates have risen dramatically due to surgical improvements and development of immunosuppressive agents. Within the African American community, many individuals have not benefited from this life-saving medical treatment because the need for donated organs outpaces the available supply. Despite tremendous advances in organ, tissue, blood and bone marrow transplantation, the need for organs and tissue for transplantation far exceeds the existing supply. Currently, approximately 90,000 individuals await organ transplantation in the United Sates; a new name is added to transplant lists every 16 minutes; however, it is estimated that 15 candidates die each day awaiting a transplant (Hader, 2006; UNOS 2005). A related persistent problem in the United States is the inequity of those who receive it. Minorities make up half of those awaiting organ transplants. African Americans in particular are often deferred, denied, or may not be offered access to the life-saving treatment of transplantation. End-stage renal disease is recognized as an important public health and medial problem in the United States and affects racial and ethnic minority groups disproportionately. Approximately 35.6% of the 39,924 persons on kidney transplant lists are African Americans; of those African Americans waiting transplantation, only 21.9% receive a donor kidney. African Americans experience a longer waiting period for organ donation: a median of 39 months compared to 20 months for Euro-Americans. African Americans are seven times more likely than European Americans to develop hypertension, which can lead to end-stage renal disease and eventual kidney failure. They are four times more likely than Euro-Americans to be on dialysis, which can best be treated by kidney transplantation. While African Americans compose 13% of the general population, according to the United Network for Organ Sharing in 2007, African Americans number nearly one third of those with renal disease awaiting kidney transplantation. The numbers underscore the point that 26,036 African Americans waited for a kidney transplant out of the total of 75,711 patients (Siminoff & Arnold, 1999; UNOS, 2007; UNOS 2005; Young & Gaston, 2002; Zaramo, Novick & Modlin, 2006). The shortage of available donor organs contributes to longer waits for transplants for African Americans with the greater risk of death. Transplantation is the treatment of choice for those with end-stage renal diseases. However, according to Callender, Miles, Hall, and Gordon (2002) of the National Minority Organ Tissue Transplant Education Program, minorities are the most likely members of society to die while waiting transplant or not being offered this treatment choice. It is urgent for African Americans to understand transplantation and donor issues and how the current shortage of donor organs affects their community disproportionately and what actions have been taken to increase donation consent. Impediments to Organ Donation Studies in the early 1970s illustrate that when families give consent in donating their deceased relatives' organs or become designated organ donors themselves, it is because of their desire to see good come out of tragedy, their sense of a duty to help others, and their acknowledgement of the altruism and life-saving capacity which donation allows (Fox & Swazey, 1970; Moore, 1992). It has been shown that the willingness to donate organs for transplantation or to designate themselves to become organ donors by signing a donor card or being registered as a bone marrow donor is lower within African American and other minority groups. According to Dr. Callender and other researchers on African American organ donor issues, the African American community share many of the same fears or concerns towards organ donation as other groups (Callender & Miles, 2000; Minniefield et al. …