| G. Caleb Alexander &
Ashwini R. Sehgal, Barriers to Cadaveric Renal Transplantation Among
Blacks, Women and the Poor, JAMA, October 7, 1998 at 1148.
This article reported on a study to determine the relative importance
of a series of transplantation steps from the diagnosis of end-stage renal
disease (ESRD) to being placed on a transplant waiting list with the ultimate
goal of receiving a transplant. The steps studied was (A) being medically
suitable and possibly interested in transplantation; (B) being definitely
interested in transplantation; (C) completing the pre-transplant work-up;
and (D) moving up the waiting list and receiving a transplant. The authors
reported that compared to whites, blacks were less likely to complete steps
B, C, and D, after adjustment for age, sex, cause of renal failure, years
receiving dialysis, and median income of patient zip code. The authors
found a significant difference at step C when race and income was factored
in. This is a critical step, because it acts as a barrier towards receiving
a transplant.
This was an excellent study because it highlighted one of the main barriers
preventing blacks from being placed on a waiting list and eventually receiving
a new organ. I found most interesting the fact that failure to complete
step C was not due to medical unsuitability or the patient's lack of interest
from receiving a transplant. It is my contention that at the local level
physicians are allowed too much discretion in selecting transplant candidates.
The authors believe there is a latent bias and financial disincentives
that play a role too. I agree, until more standardized rules are formulated,
this disparity in organ allocation among blacks and whites will continue.
This article contained neither a bibliography nor footnotes.
Black Ministers Urging Congregation
To Become Organ, Tissue, Blood Donors, Transplant News Aug. 31, 1998, 1998
WL 9525582.
This article documents the efforts of the Congress of National Black
Churches (CNBC), made up of eight denominations urging members of their
congregations to become organ, tissue, and blood donors. One of the religious
leaders expressed his hope to "dispel any myth or mystery that we need
all of our body parts to get to heaven." Another minister stated that this
is untrue, since "it is the soul that leaves the earth while our physical
presence is left behind." The ministers believe that their efforts will
have a positive impact towards increasing the number of organ donors.
Since the church pays such a critical role not only in the black community,
but in other communities as well, this effort is an excellent first step
for increasing organ donations because it would help in dispelling any
fears an individual may have. One reason is religious leaders have the
trust of members of the community. If these ministers are successful, they
need to spread the message to other cities and congregations.
This article did not include a bibliography or footnotes
Phyllis Coleman, "Brother, Can You
Spare A Liver?" Five Ways To Increase Organ Donation, 31 Val. U. L. Rev.
1 (1996).
This is an article focusing on the expanding the supply of available
organs. The current transplant program depends on altruism, where individuals
decide to donate organs because it is the right thing to do. The author
listed a number of possible solutions including: A procurement market system,
non-cash payments, required requests, presumed consent, conscription, new
perfusion technique, Pennsylvania's Organ Donation Awareness Trust Fund,
and the Cadaveric Organ Donor Act.
The author proposed her own solutions which included: Permitting death
row inmates to donate organs, compliance with patient wishes, a license
fee discount, and a national registry with detailed procedures. The suggestion
allowing death row inmates to donate organs was the most radical suggestions
offered. However, it may not work because it would require a change in
execution techniques and it is hard to envision the removal of a prisoner's
organs before execution. The most viable method is to respect the patient's
wishes. If hospitals and doctors followed the law, it would help to increase
the supply of donor organs.
This article did not contain a bibliography, but provided extensive
footnotes.
Bertram L. Kasiske, et al., The Effect
of Race on Access and Outcome in Transplantation, 324 NEJM 302 (1991).
This is an article reporting the conclusions and recommendations from
the Patient Care and Education Committee to the American Society of Transplant
Physicians to examine the issue of racial inequality in organ transplantation.
The committee found that first; end stage renal is more common in racial
minorities than in whites. Second, fewer blacks than whites undergo kidney
transplantation. The committee found that biological and sociological factors
play a role in this disparity. Third, the rate of survival after renal
transplants is lower among blacks than whites. Factors accounting for this
may be differences in MHC antigens, patient noncompliance, and socioeconomic
factors. Fourth, the rate of survival among Hispanics and Asians may be
similar to whites, but more research is needed to confirm these findings.
Lastly, problems of racial and ethnic inequality may carry over to liver
and pancreatic transplants where the proportion of transplantation is lower
than expected for blacks compared to their percentage of the population.
The committee made the following recommendations. First, examine data
from the OPTN and other sources to determine how differences in tissue
antigens influence organ transplantation rates among minorities. Second,
critically examine the process of selecting patients on dialysis for renal
transplantation. Interviews with patients and health care providers may
uncover why qualified candidates remain on dialysis. Third, assess the
differences in public and private insurance plans that may limit access
to transplantation. Fourth, examine the process that leads to placement
of a patient on the wait list to uncover any possibility of favoritism.
Fifth, examine the reasons why the rate of survival in blacks following
transplantation is lower than whites. Issues of education after surgery
and compliance may reverse this trend. Sixth, examine the effect of race
on the transplantation of livers, the pancreas, and other organs. Finally,
the committee encouraged health care providers to increase their advocacy
role in providing the most appropriate form of treatment.
I found this to be one the most comprehensive articles I have read on
transplantation in regards to its recommendations for increasing greater
equality for minorities or areas that need further investigation to uncover
reasons for racial disparity in organ allocation. It is my hope that the
recommendations will be forwarded to the Secretary of HHS and officials
at UNOS so they may incorporate these ideas for balancing organ allocation
equally across all racial lines.
James F. Childress, Ethical Criteria
for Procuring and Distributing Organs for Transplantation, 14 Journal
of Health Politics, Policy and Law 87 (1989).
This article provided an ethical analysis and assessment of various
actual and proposed policies of organ procurement and distribution in light
of moral principles. Childress evaluated four different methods of acquiring
human body parts (HBP): 1. Donations (express and presumed),
2. Sales, 3. Abandonment, and 4. Expropriation. The author advocated
continuing with donations and allowing it time to work before moving towards
a market as an alternative. Childress reported that the federal Task Force
on Organ Transplantation considered organs to be a natural resource that
belonged to the community to be used for the public good. I find this statement
to ring hollow after the author reported that of the 6,000 kidneys transplanted
in the U.S. in 1985, 300 were transplanted to nonresident aliens who came
to the U.S. for medical care and another 200-250 kidneys were shipped abroad
for use in other countries apparently at taxpayers expense. The author
reported that access to transplantation hinged on patient choices and legitimate
patient factors rather than on the provider's failure to inform and refer
some groups of patients.
To allow foreign nationals to obtain organs in the face of an organ
shortage, and lower access for minorities to waiting lists, who are U.S.
citizens is outrageous. It undermines the confidence that people need to
have in order to increase organ donations. The fact that we as taxpayers
are paying for organ procurement serves to deepen my disgust. My question
is what access to foreign organ donors do we have? Also, considering that
the "green screen" affects minorities in such a negative way, any costs
associated with organ procurement for aliens should come their own government,
not ours. The author did not report on this, but more information is needed.
Out of all the articles I have read and commented on this revelation has
angered me the most.
This article contained no bibliography or footnotes.
Mark F. Anderson, The Future of Organ
Transplantation: From Where Will New Donors Come, To Whom Will Their Organs
Go? 5 Health Matrix 249, 301 (1995).
The author observed that under the current system of organ allocation,
patients are placed on waiting lists according to criteria developed by
local transplant teams. Anderson believed the subjectivity in patient selection
on the list created an opportunity for abuse, favoritism, and unequal treatment
based on class, race, or other prejudices. He believes that changes in
the criteria used to place patients on the waiting list or selecting them
once they are placed on the list is needed to avoid the untoward results
that occurs under the current system. Anderson felt that considerations
of utility should be paramount since resources are limited. He also looked
to outlaw multiple organ transplants, repeat transplants, and transplants
to critically ill patients who will probably die with or without a transplant.
I believe that the subjectivity of the transplant teams placing patients
on waiting list is the number one issue confronting minorities. Changes
must definitely be made at the local level. I agree with the author when
he states that living donors are a resource that should be further explored
without paying organ donors. However, who would agree to donate a kidney
or a lung unless it was to a family member? It is also the author's contention
that principles of distributive justice and fairness are needed. I agree
with this statement, but I cannot reconcile this with the advocacy of outlawing
multiple or repeat transplants. What if there was a small child who was
a potential recipient of an organ? Who could not refuse considering a patient
like this without balancing the factors needed for placement on a waiting
list? I view the author's proposals on this point as too callous.
This article did not contain a bibliography, but included extensive
footnotes.
Fred A. Cate, Human Organ Transplantation:
The Role of Law, 20 J. Corp. L. 69 (1995).
This article focused on the role of the legal system regulating organ
donation and transplantation. He listed alternatives to the transplantation
problem are presumed consent, compensation, and medical alternatives to
cadaveric donors. Cate explained that lawyers have at least three roles
to play in order to decrease the ambiguity of the law on transplantation
and to increase organ donation. First, lawyers must help investigate alternatives
to current transplant practice and participate in modifying the current
legal structure. Second, lawyers have an opportunity to raise the issue
of donation with their clients, provide accurate information regarding
the legal rights of every adult and ensure the client's wishes is followed.
Third, and Cate says is most important for lawyers, is to guarantee the
integrity of the organ procurement, distribution, and transplantation system.
I agree with Cate when he states the public must have confidence in
the fairness government if we as a society hope to benefit from an increase
of organ donation. I also believe that to avoid the "green screen" where
no one is placed on a waiting list for an organ without demonstrating an
ability to pay needs to be addressed. Patients need to have access to insurance
possible or we will be perpetuating the belief that only the wealthy will
have the opportunity for procuring a transplant while the poor are left
behind. I also believe that attorneys are uniquely skilled in changing
the current system for the better. I also believe that Cate has a good
idea in switching the presumption of the law from organ denial to organ
donation.
This article does not contain a bibliography, but has extensive footnotes.
Daniel S. Gaylin, et al., The Impact
of Comorbid and Sociodemographic Factors on Assess to Renal transplantation,
269 JAMA 603 (1993).
This article reported on a study showing that patients with cardiovascular
diseases showed a lower transplantation rate compared to patients without
the disease. Obese patients and diabetics were also placed at a disadvantage.
The authors concluded sociodemographics are a factor for patients being
placed on the transplant list. The authors also reported that smokers had
lower transplantation rates than nonsmokers, but were not surprised by
this since smoking is an indicator of a life-style choice and is associated
with a high mortality.
When you consider that blacks and other minorities frequently have greater
health problems than whites it gives decision-makers another excuse to
hide behind their choice not to place a person on the transplant waiting
list. Unless there is a change in the entire health care system addressing
access to medical care, it is unlikely this situation will improve soon.
In order to increase their chances, blacks and other minorities must take
the first step towards making healthy life changes and remove as many obstacles
for transplant selection as possible.
This article did not contain a bibliography or footnotes.
Daniel G. Jardine, Liability Issues
Arising Out of Hospitals' and Organ Procurement Organizations' Rejection
of Valid Anatomical Gifts: The Truth and Consequences, 1990 Wis. L.
Rev. 1655 (1990).
This article proposes that potential donor recipients bring legal claims
against doctors and hospitals that refuse the decedent's organ donor gift
because they failed to get consent from the next of kin. Jardine's purpose
for introducing these claims are: (1) to eliminate the hesitation of hospitals
and organ procurement organizations (OPO) to accept valid anatomical gifts;
(2) To give hospitals and OPOs a tool, i.e. legal leverage, to use when
discussing a decedent's organ donation with next of kin; and (3) To recognize
the rights of and wishes of decedent donors and beneficiaries-recipients.
The causes of action Jardine proposes potential recipients take against
donees are negligence. Actions against the next of kin include tortious
interference and invasion of privacy.
I find Jardine's approach to be quite interesting and novel. On the
other hand, I am not so sure that anyone would pursue such a cause of action.
I believe that education of the laws to doctors and hospitals is needed
rather than litigation. My concerns are what measures will be undertaken
to prevent hospitals from abusing patient rights if the UAGA is enforced
and doctors and hospitals are shielded form lawsuits. There would have
to clear indications that there is no counterfeit permission procured.
However, I do agree that the UAGA should be enforced as long as donor wishes
as valid.
This article contained no bibliography, but extensive footnotes.
Clive O. Callender, Organ Donation
in the Black Population: Where Do We Go From Here? 19, No. 2, Suppl.2
Transplantation Proceedings 36 (1987).
Clive Callender has been an advocate for increasing organ donor awareness
in the black community for years. Callender reported on a task force formed
in 1984 to study the impact of health care in the black population with
these findings: (1) The primary cause of renal disease in blacks is hypertension;
(2) Hypertension was the dominant cause in renal disease in 40% of blacks
and the cause of renal failure in 20% of white patients; (3) the most frequent
primary cause of death for ESRD in 1983 was hypertensive nephrosclerosis
(33%) occurs most commonly in blacks; and (4) diabetic kidney disease was
the second leading cause of death in patients with ESRD. Callender also
reported that only 10% of blacks compared to 20% of whites opted for transplantation.
The most common reasons for lack of donation of organs among blacks were:
lack of information, religious fears, superstition, distrust of the medical
community, fear of premature death, and racism (blacks would prefer to
give their kidneys to other blacks).
I agree with Callender that more research is needed to study black histocompatibility
antigens where little information exists. This article provided excellent
ideas for initiating a grass roots campaign for organ donations in the
black community. Callender found that a face-to-face approach involving
the entire community, lay people, experts speakers presenting a sophisticated
slide show presentation, gift of life posters and gift of life donor cards
were just a few of the excellent ideas reported to increase minority participation
for becoming organ donors. Callender also suggested that if individual
signs a donor card they should discuss it with members of their family
before tragedy strike. I also found the Minority Perspective Fact Sheet
incredibly informative.
This article did not contain a bibliography or footnotes.
Luis M. Perez, et al., Organ Donation
in Three Major American Cities With Large Latino and Black Populations,
46 transplantation 553 (1988).
This article studied family refusal rates (FRR) to cadaver organ donation
in three large U.S. cities, New York, Los Angeles, and Miami, with large
Black and Latino populations. The authors found that blacks and Latinos
were 42% of the transplant recipients, 49% of patients on waiting lists
and 57% of patients on dialysis in the three cities. At the same time,
the FRR was 45% for blacks and 43% for Latinos. Because of the high family
refusal rates, the authors estimated that at 1000 transplantable kidneys
were lost over a forty-month study period. The authors cited the two main
reasons why a potential donor does not become an actual donor are, lack
of consent and lack of referral. The authors to their credit gave an extensive
list of reasons why blacks and Latinos have such high family refusal rates.
I believed this article was very informative regarding low donation
rates in the Latino community. I agree with the authors that further study
is needed to uncover the reasons for differences in donation rates among
these groups and in the region overall. I also believe that a low number
of minority professionals may be hurting our chances to communicate with
people of different cultures and languages. Current providers must learn
to reach out for everyone to benefit from organ donations.
This article contained no bibliography or footnotes.
Organ Transplantation, 103 Harv.
L. Rev. 1519, 1614 (1990).
This article discusses the problem of obtaining an adequate supply of
donor kidneys and developing an equitable system for distributing scarce
medical resources. The authors described current efforts in the selection
of a recipient for donor organs as a two-staged process. The first phase
is when private transplant teams determine which patients to place on waiting
lists. The second phase of the recipient selection process is governed
by "objective" medical criteria. In the first phase, minimal legal rules
exist in selecting patients for the all-important waiting lists. The authors
criticized the arbitrary decision-making of physicians excluding seemingly
eligible patients from the transplant waiting list. The authors surmise
that when physicians are forced to choose patients from a large pool they
most likely will choose people most like themselves and exclude those they
deem "unworthy." The authors felt that the second phase presented difficult
ethical choices where two values compete: urgency of need and the probability
of successful transplantation.
The authors analyzed constitutional safeguards of the Due Process Clause
and Equal Protection Clause, however they concluded that due to lack of
state action, the distribution of transplantable organs did not fall under
either area of constitutional protection. Since blacks receive a disproportionately
high share of kidney transplants compared to their rate of donation, it
would be difficult for a black plaintiff to prove any discriminatory intent.
The authors did surmise that a potential transplant candidate was entitled
to a hearing and may even have a cause of action, such as a malpractice
suit to curb physician discretion in the selection of patients on the waiting
lists.
I believe the authors are correct in targeting the discretion that physicians
have in placing patients on the transplantation list, and more research
in this area is needed. The authors did not appear to disagree with UNOS's
system giving more weight to quality of antigen match, and were willing
to continue adhering to the current system compared to other alternatives.
However, I disagree that UNOS's current point scheme is preferable to others
because it affects minorities disproportionately and should not be tolerated
but instead modified.
This article contained no bibliography, but provided extensive footnotes.
Edgar L. Milford, Organ Transplantation-Barriers,
Outcomes, and Evolving Policies, JAMA, Oct. 7, 1998 at 1184.
This article reported on recent discussions between the Secretary of
HHS and UNOS addressing the issue of fairness and effectiveness of organ
allocation. One proposed HHS regulation would require that patients have
equal waiting times towards a transplant or that the "sickest" patients
have the first opportunity to receive a transplant. The author believed
that a set of rules could be drafted that would increase the number of
years of patient life or organ function. However, the author believed that
this would be unfair to minorities. The author also disagreed on a "first-come,
first-served" allocation scheme as inefficient, since many recipients may
not have as favorable an outcome as other more promising candidates may.
The author reported on one promising solution utilized in the New England
region. A system factoring in patent urgency, waiting time, geographic
relation of donor to recipient center, histocompatibility match, and candidate
sensitization. The results have led to more equitable allocation to blacks
and Hispanics while also ensuring a reasonable amount of local access to
organs.
It is my contention that the results of the New England experience be
incorporated into any proposals that may be developed by HHS and UNOS.
Based on the results, other regions should adopted and implement the same
type of system that would use the very same factors. The current system
is unfair to minorities and effective and reasonable solutions deserve
careful review. However, the article indicated more organs need to be donated
from minorities. I agree, however in the meantime steps need to be taken
provide for equitable allocation among all races.
This article did not contain a bibliography.
J. Michael Soucie, et al., Race and
Sex Differences in the Identification of Candidates For Renal Transplantation,
19 American Journal of Kidney Diseases 414 (1992).
This was a study on patients with ESRD in North Carolina, South Carolina,
and Georgia. The authors found significant differences in the likelihood
of being selected for a transplant between white and black patients. The
authors found that diabetic patients were less likely to be selected as
candidates were than nondiabetics were. In addition, patients on dialysis
longer than two years or more were less likely to transplant candidates.
The fact the authors found that diabetics and patients on dialysis for
a long period of time are less likely to be candidates is a direct correlation
for why blacks have lower access. More blacks with ESRD have a higher co-morbidity
than whites and are on waiting lists as a Race almost twice as long as
whites. As long as providers are allowed the discretion in choosing patients,
this situation will not change.
This article contained no bibliography or footnotes.
Paul W. Eggers, Racial Differences
in Access to Kidney Transplantation, 17 Health Care Financing Review
89 (1995).
This article studied access to transplantation using three measures:
time from renal failure to transplant; time from renal failure to wait
listing; and time from wait listing to transplantation. The study found
that no matter what measure is used, blacks with end stage renal disease
(ESRD) were worse off than Whites, Asian-Americans, and Native Americans
with ESRD. The authors found that the enrollment process was critical towards
receiving a transplant. The authors cited the Asian Americans as an example.
This group had a lower rate of transplantation than whites after wait listing,
but due to higher enrollment rate on the wait list, they overtake white
patients in transplantation rate within a five-year period after being
diagnosed with renal failure. The authors stated that it was important
to increase black enrollment on the OPTN with education and outreach efforts,
however they cited the limiting factor was an organ shortage.
I conclude that the key factor for minorities not getting on the waiting
list is attitudinal factors from organ providers as well as attitudinal
factors among black persons as well. I disagree with the authors who contend
that biological factors play a significant role simply because blacks are
not a favorable antigenic match with a white donor. I believe that if there
is lack of access to the wait list there will be no chance at receiving
a donor organ. I do believe that there should be less weight given to HLA
matching because this would result in increase of minority access rates.
This article did not contain a bibliography or footnotes.
Robert S. Gaston, et al., Racial
Equity in Renal Transplantation, 270 JAMA 1352 (1993).
This article reports on the current system of organ allocation based
on quality of HLA matching. The authors report that based on available
evidence, antigenic similarity between donor and recipient may enhance
cadaveric graft survival and should be the primary factor influencing organ
allocation. The authors contend however, this system places blacks at a
significant disadvantage because most donors are white and the closer the
HLA match, the less likely a kidney will cross racial lines. The authors
assert all suitable renal transplant candidates should have equal access
to kidneys and the system should reevaluate whether the cost in equity
is justified. This position is based in part on recent data indicating
that survivability for all recipients receiving their first graft regardless
of HLA match is equal to recipients with the best match. The advent of
immunosuppressant agents such as cyclosporine is responsible for these
results.
It is clear that blacks are at a disadvantage when only HLA matching
is used for organ suitability. This only exacerbates the plight of blacks
when you consider they as a group are placed on a transplant list less
frequently than whites, wait twice as long, and as a race donate fewer
organs. I believe there must be greater educational programs to increase
organ donations, however changes must be made in the criteria for patient
selection of a transplant.
This article does not contain a bibliography
Mary E. Hagle, et al., Racial Perspectives
on Kidney Transplant Donors and Recipients, 48 Transplantation 421
(1989).
This article examined the demographic patterns of kidney recipients
and donors in the city of Detroit and the state of Michigan. What is most
interesting about this study is that kidney donations from Michigan were
13% black and 85% white. Since the population in Michigan is 13% black,
the donation rate of blacks in the state perfectly matches their percent
population throughout the state. The authors concluded that their data
should be utilized in other areas where there is a campaign for organ donations
among minorities. The results were from conducting face-to-face education
programs in the community with the goal of modifying attitudes. The authors
also targeted their audience rather than use a more generalized, nonspecific
program.
This article has convinced me that a systematic, educational campaign
targeting blacks are effective for increasing the donation rate in the
black community. If programs are implemented in other minority neighborhoods,
the positive results reported in this article may be duplicated.
This article did not contain a bibliography or footnotes.
Jeff Testerman, Should Donors Say
Who Gets Organs? St. Petersburg Times, Jan. 9, 1994, at 1A.
This article reported a murdered Ku Klux Klansman's family agreed to
donate his organs, but only to people whom were white. This fueled a debate
about anti-discrimination and autonomy of choice in organ allocation. Directed
donations falls into three categories: (1) The most common is the "living
related," donation to a blood relative; (2) the "loving-related," when
a donor gives an organ to a loved one not a blood relative; and (3) the
gift of an organ to a generic class, illustrated in this case. Most ethicists
and transplant center officials deplored the acceptance of the organs based
with discriminatory overtones. However, Dr. Clive O. Callender, a prominent
black transplant surgeon indicated that have accepted any organ if it meant
saving other lives, although he discourages directed donations. The biggest
worry is that more and more donors will exercise their right to choose
their recipients. The long-term effects could undermine the process of
getting organs to the people who need them the most.
If directed donations were based on racial preference, then all Blacks
who make up a disproportionate percentage of patients on transplant waiting
lists compared to their overall population percentage in the country will
be completely shut out from receiving an organ. This is because nearly
90% of the organ donors are white and black donors could not make up the
difference in a short period. In the reverse situation, many blacks want
to see their organs donated to other blacks. This is racism, too. It should
not make a difference what race the recipient is; the goal is to give a
recipient a second chance at life. On the other hand, this issue could
stimulate needed changes in the current allocation scheme.
This article did not contain a bibliography or footnotes.
A. H. Barnett, David L. Kaserman, The
Shortage of Organs for Transplantation:Exploring the Alternatives,
9 No. 2 Issues in Law & Medicine 117 (1993).
This article evaluated the proposed organ procurement system. The author
identified two reasons organ donations may not occur. The first is potential
donors (or surviving family members) may refuse to donate. Second, the
request for donation may fail to occur. The alternative procurement programs
dealt with in the article include 1) express donation (the current system);
2) presumed consent; 3) conscription (or organ draft); 4) routine request;
5) compensation; and 6) a market system.
The authors found that when the alternatives were ranked between physicians,
they preferred conscription and organ markets the most and express donation
the least. Without physicians, the ranking between taxpayers, donors and
transplant recipients suggested a preference for an organ market the most
and express donations the least. The authors conceded that their approach
was imperfect, however they did not consider their findings to be the final
word. However, this article did demonstrate that the need for a policy
change is evident and needs to be replaced.
Vernellia R. Randall, Slavery, Segregation
and Racism: Trusting the Health Care System Ain't Always Easy! An African-American
Perspective on Bioethics, 15 St. Louis U. Pub. L. Rev. 191 (1996).
In this article the Randall asserts that African-Americans have disparate
access to organ transplantation. The author found that although European
Americans represent only sixty-one percent of the dialysis population,
they receive seventy-four percent of all kidney transplants. In contrast,
Randall cited 1988 statistics showing African-Americans represented 33.5%
of dialysis patients, but only 22.3% of the transplants. She also stated
that most authorities believe this disparity is due to a low rate of organ
donation in the black community, however Randall asserts the difference
is due to the federal mandated program emphasizing antigen matching.
She listed two issues confronting African-Americans. One, is lack of
equitable access to available organ transplants. The other is based in
the black community itself. Randall listed the following factors influencing
organ donor reluctance: lack of information; religion; distrust of medical
professionals; fear of premature death; racism (a preference to donate
only to members of the same race); and the failure of health care professionals
to ask African-Americans families for consent in an effective way.
I agree with Randall's analysis in pointing out the reasons why there
is such a disparity in organ allocation between white and black recipients.
I think distrust in the black community must be overcome if there is any
hope of increasing organ donation. One way of accomplishing this is the
creation of outreach programs to educate the community. African Americans
must be willing to help participate in solving this problem if they ever
hope to improve the current situation. It is also incumbent among health
professionals to understand the culture of people unlike themselves, otherwise
the scarce resources that already exist will not increase because if a
family is never asked to donate an organ then the potential donors' organs
are wasted and that helps no one.
This article does contain a bibliography, however it provided extensive
footnotes.
Robert A. Hahn, The State of Federal
Health Statistics on Racial and Ethnic Groups, 267 JAMA 268, (1992).
This article focussed on assumptions underlying federal health statistics
on racial and ethnic groups in the United States. The four assumptions
examined were: 1) The categories of 'Race' and 'Ethnicity' are consistently
defined and ascertained by Federal data-collection agencies; 2) Racial
and ethnic categories are understood by populations questioned; 3) Survey
enumeration, participation, and response rates are high and similar for
all racial and ethnic populations; and 4) Individual responses to questions
of racial and ethnic identity are consistent in different surveys and different
times. The authors found several of these assumptions were not supported
by the data.
I agree with author where it is asserted the implications of these results
are that inconsistencies in data may hinder health research and program
development. Race is an important factor towards receiving adequate health
care and for clinical studies. Consistent statistics are important for
health planning and research. This article demonstrates that statistics
about United States health may be misleading.
This article did not contain a bibliography or footnotes.
Jim Warren, Transplant Community
Outraged Farrakhan Says Whites Condone Black-on-Black Killings Because
It's a Source of Transplantable Organs, Transplant News May13, 1994,
1994 WL 2974685.
This article reports on a speech delivered by Louis Farrakhan, leader
of the Nation of Islam, where he charged that whites do little in combating
black-on-black crime because victims provide a supply of organs for whites.
Needless to say, these comments were vehemently denied in the transplant
community. Alan Hull, MD, vice president of the National Kidney Foundation
asserted that race is not a factor in deciding who receives an organ transplant.
The reason is that organs are matched according to blood and tissue type.
The article reported that in 1992, more than two-thirds of the total number
of kidneys transplanted into blacks came from whites. John Arradondo, co-chairman
of the NAACP National Health Committee, stated that others hold Farrakhan's
views in the black community. This distrust is from the "Tuskegee experiment"
where black men were left untreated for syphilis for a government study
and from studies reporting unequal treatment between whites and blacks
for heart disease.
As usual, Farrakhan is pandering to the fears and distrust of members
of the black community. I believe that if he really wanted to help he would
work to stop Black-on-Black crime in the black community. In addition,
assuming his statement was true, it has had minimal impact on increasing
the number of donor organs to the blacks already on transplant waiting
lists. Since the current policies place a great deal of emphasis on antigen
matching, it would not be whites that would benefit the most, but rather
other blacks. I believe Farrakhan's comments could hinder efforts to increase
organ donation among blacks and were irresponsible.
This article did not contain a bibliography or footnotes.
Ian Ayers, et al., Unequal Racial
Access to Kidney Transplantation, 46 Vand. L. Rev. 805 (1993).
This article explores whether the negative racial impact of the current
mandated antigen matching scheme is justified by higher overall survival
rates of kidney transplants. The authors conclude it does not. One reason
is the availability of technological advances combating organ rejection.
Because of current technology, any federally mandated program allocating
organs based on antigen matching, has a weak correlation to patient survival
and is outmoded. The authors propose allocation rules that would: (1) eliminate
points for patients with two or more mismatched antigens, (2) increase
points for time on the waiting list, and (3) award points for patients
with rare antigens. The authors also state that a cause of action may exist
for a private plaintiff who wish to file a challenge under Title VI to
force compliance of private entities receiving public funds. Two targets
are the private entity itself (UNOS) and the federal agency responsible
for its funding (HHS).
I agree with the authors that allocation policies should not remain
static, but rather should be systematically and routinely evaluated to
keep pace with ever-changing technological advances. Out of the three proposals
listed above I believe the second point would help African-Americans the
most since they tend to be on waiting lists twice as long as their white
counterparts. On the other hand, I agree that it is important to increase
donation in the black community, but donations are not enough to close
the wide gap between the scarcity of organ supply and growing demand.
This article does not contain a bibliography, but provided extensive
footnotes.
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