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Organ Donation and Transplantation

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Vernellia R. Randall
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The Effect of Organ Donation and Transplantation
on America's Ethnic Minorities
An Annotated Bibliography

The University of Dayton School of Law
Spring 1998


A recent study revealed that members of certain minority groups, young children, and women remain on waiting lists for liver transplants longer then their white, adult male counterparts. (1)

Ironically, the study also revealed that foreign nationals and repeat transplant patients are among those who wait the least amount of time for these transplants.(2) These findings suggest that certain groups may be at a disadvantage where organ transplantation is concerned. This troubling data requires that issues surrounding access to organ transplantation are further pursued in order to determine what causes this predicament, and what can be done to remedy the situation. This annotated bibliography attempts to provide insight on the practices of organ transplantation and organ donation. However, specific emphasis is placed on how these practices impact members of minority groups, especially African-Americans.

Several factors have been cited as causes for the racial disparities in organ donation and transplantation. Factors attributed to disparities in organ donation include: lack of education, religious beliefs, distrust of the health care system, lack of communication between health care providers and minority patients, and desire of minority members to donate their organs only to members of their same ethnic classification.(3)

Disparities in access to transplantable organs can be attributed to the strong preference for antigen matching promulgated by the Organ Procurement and Transplantation Network (OPTN).(4)  The more similar the donor and the recipient are genetically, the more likely the chances that the antigens will match.(5) Thus kidneys from white donors will most likely be given to white recipients, even where African-Americans, and other individuals with slightly distinct genetic make-up have waited longer on the same recipient list. (6)

Irrespective of the causes of this predicament, or the claims made by the authors reviewed in this bibliography, there is only one way to begin remedying this dilemma. In the words of the Secretary of the Department of Health and Human Services, Donna E. Shalala, the "real answer to the problem of scarce organs is to increase the amount of organ donations." (7) The rate of organ donation among African-Americans has increased in recent times.(8)

If this trend continues, justice in access to organs may follow. However, this justice cannot result from donation alone given the disproportionately high number of African-Americans with end stage renal disease. If African-Americans fail to donate their organs, African-Americans in need of these scarce commodities will undoubtedly be overlooked, and will have to wait longer to receive transplants. If African-Americans, and all other members of our society for that matter, begin donating their organs at a higher level of frequency, organs will not be as scarce, and more organs will be available to all patients in need, including African-Americans. Failing to donate organs because the system is biased is a self-fulfilling prophecy. This is because the system will isolate or show apathy toward the needs of those who remain apathetic, or who isolate themselves from the system. The cycle is endless, and the needs of these forgotten individuals will continue to fall on deaf ears. In order to prompt action we must empower ourselves by taking action. We must become a part of the system, and we must contribute to the system.

Final Thought"The day will come when my body will lie upon a white sheet, neatly tucked under four corners of a mattress, located in a hospital busily occupied with the living and the dying. At a certain moment a doctor will determine that my brain has ceased to function and that, for all intents and purposes, my life has stopped." "When that happens, do not attempt to instill artificial life into my body by use of a machine. And don't call this my deathbed. Let it be called the Bed of Life, and let my body be taken from it to help others lead fuller lives."

"Give my sight to the man who has never seen a sunrise, a baby's face or love in the eyes of a woman. Give my heart to a person whose own heart has caused nothing but endless days of pain. Give my blood to the teen-ager [sic] who was pulled from the wreckage of his car, so that he might live to see his grandchildren play. Give my kidneys to one who depends on a machine to exist from week to week."

"Take my bones, every muscle, every fiber and nerve in my body and find a way to make a crippled child walk. Explore every corner of my brain. Take my cells if necessary, and let them grow so that, someday, a deaf girl will hear the sound of rain against her window. Burn what is left and scatter the ashes in the winds to help the flowers grow. If you must bury something, let it be my faults, my weaknesses and all prejudice against my fellow man. Give my sins to the devil. Give my soul to God. If by chance you wish to remember me, do it with a kind deed or word to someone who needs you. If you do all I have asked, I will live forever."(9)

Make a Miracle, Be an Organ Donor!!

The following articles are included in this bibliography:
Analyzing the OPTN Under the State Action Doctrine--Can UNOS's Organ Allocation Criteria Survive Strict Scrutiny

Brother Can You Spare a Kidney? Five Ways to Increase Organ Donation

Human Organ Transplantation: The Role of Law

Increasing Organ Donation

Increasing the Supply of Cadaver Organs For Transplantation: Recognizing that the Real Problem is Psychological Not Legal

Issues and Controversies Surrounding Organ Donation and Transplantation: The Need for Laws That Ensure Equity and Optimal Utility of a Scarce Resource

Liability Issues Arising Out of Hospitals' and Organ Procurement Organizations' Rejection of Valid Anatomical Gifts: The Truth and Consequences

Living Tissue and Organ Donors and Property Law: More on Moore

Medical Progress: Procurement and Allocation of Solid Organs for Transplantation

Organ Transplantation-The Potential Supply of Organ Donors: An Assessment of the Efficiency of Organ Procurement Efforts in the United States

Racial Equity in Renal Transplantation: the Disparate Impact of HLA-Based Allocation

Racist Health Care

Slavery, Segregation and Racism: Trusting the Health Care System Ain't Always Easy! An African American Perspective on Bioethics

Unequal Racial Access to Kidney Transplantation

Why Buy an Inexpensive "Home Lawyer" Program? A Look at Quicken Family Lawyer Software



Benjamin Mintz, Analyzing the OPTN Under the State Action Doctrine--Can UNOS's Organ Allocation Criteria Survive Strict Scrutiny, 28 Colum. J. L. & Soc. Probs. 339 (1995).

This article explains that the Organ Procurement and Transplant Network (OPTN) policies surrounding organ donation and transplantation would not survive strict scrutiny if subjected to a constitutional challenge. The main problem with the OPTN policy is the preference for antigen matching. However it is questionable whether the Supreme Court would consider the OPTN a state actor. If, in the future, the Department of Health and Human Services seeks to adopt the current system as binding on transplant centers, then constitutional issues will arise.

Mintz does not find that the current system is improper, he does believe that the current United Network of Organ Sharing (UNOS) system is not tailored narrowly enough to survive strict scrutiny. He believes that strict scrutiny is the only way to review the UNOS system because the system of antigen matching has a racially discriminatory effect. Thus the system violates equal protection because other, less restrictive alternatives are available to aid in organ transplantation.

This article was interesting to say the least. It is unbelievable that a system is accepted as common practice, and implemented by organ transplant centers nationwide when this very same system, if mandated would not survive strict scrutiny. The system of antigen matching is not discriminatory on its face, however, as applied there is no question that it has a disparate impact on racial minorities, especially African-Americans. A system which has such a discriminatory impact on this country's racial and ethnic minorities should not be mandated. Requiring the implementation of this system does nothing more then create a tolerance for the racial inequalities that the system perpetuates and open the system up to constitutional challenge. Neither of these results are desirable, so the Department of Health and Human Services should conclude that this practice need not be mandated.

This article does not contain a bibliography, however, it supplied extensive footnotes.


Phyllis Coleman,Brother Can You Spare a Kidney? Five Ways to Increase Organ Donation, 31 Val. U. L. Rev. 1 (1996).

In her article, Coleman maintains that the current organ shortage requires that transplant officials employ new means by which to procure much needed organs. Coleman presents various methods which could potentially increase the number of organs available for transplantation. These solutions include: commercial markets; non-cash payments; the requirement that hospitals ask families of their desire to donate their loved one's organs at the time of death; presumed consent; conscription, a process by which organs could be removed without consent; employment of a technique to prolong life in the case that no organ donor card can be located, and no family members can yet be contacted; establishment of trust funds to give the families of donors a stipend to be spent on health care expenses and funeral costs; and a consent/refusal to donate provision to be placed on social security cards to promote awareness. The author also suggested discounts on driver's license renewal with consent to donate, and allowing death row inmates to donate their organs.

I must say that this article proposed many unique ways to increase organ donation. At the top of the list however, were methods which would compensate individuals monetarily or otherwise in consideration for their anatomical gift. While I believe that many individuals do not possess the level of altruism necessary to donate their vital organs and receive nothing in return, I do not advocate any form of payment for organ donations. Any payment, or offer to cover certain medical or funeral expenses, will undoubtedly have an effect on who donates organs. Even though our goal is to increase the amount of available organs this type of system will adversely impact the poor. Individuals will not thoroughly think through their decisions to donate. They will be motivated by the call of dollars, and will begin selling their organs to the highest bidders. I cannot advocate such a system, and thus I must disagree with the implementation of these sorts of measures. Neither do I agree with prolonging an individual's life solely in hopes of procuring their organs. I agree with a system which requires hospitals to ask all families if they will donate the organs of their departed relative. I also agree with all measures introduced to promote awareness, especially where the organs of young children are concerned. I have faith in these types of efforts, and although they may not have as great an effect as monetary and other compensation, they educate the community and allow for the formulation of sound decisions regarding patient self-determination.

This article did not contain a bibliography, however, it supplied adequate footnotes.


Fred H. Cate, Human Organ Transplantation: The Role of Law, 20 J. Corp. L. 69 (1995).

This article explains the role of the legal system as it relates to the law of human organ donation and transplantation. In his article, Cate emphasizes the role of attorneys in the process of organ procurement and distribution. According to Cate attorneys play three distinct roles in the process. First attorneys must help to research alternatives to current practices regarding transplantation, and alter the se procedures where necessary. Second, attorneys should raise the issue of organ donation with their clients. Finally, and most importantly, attorneys must commit themselves to guaranteeing the integrity of the organ procurement, distribution, and transplantation system. Cate explains that because the organ donation/transplantation system does not appear fair to certain members of our society, namely African-Americans, they will not donate as at high a rate as those to whom the system appears fair, namely White Americans.

I agree with Cate's argument. The only way to ensure justice in this system is to vest all power in the hands of those who know the system, and know how to manipulate the system. Attorneys are the best suited for this job. Attorneys should assist physicians and researchers in attempting to ameliorate the current system. In estate planning matters attorneys should raise issues of organ donation with clients. This is clearly a component of planning for the future. Finally attorneys should attempt to create trust in the system through attempting to guarantee its integrity. Once people trust the system they will be more likely to participate in it. As Cate pointed out, until action is taken to create a system which African-Americans can trust they will continue to refuse donation of their organs, thus refusing participation in a system they view as unjust.

This article did not contain a bibliography, however, it supplied adequate footnotes.


Antonia C. Noello, Increasing Organ Donation, Journal of the American Medical Association, Jan. 8, 1992.

In an effort to increase organ donation a workshop was sponsored by the United States Surgeon General. The reasons for this workshop as well as the goals and objectives of the program are described in this article. The program was coordinated by Mary Ganikos and Dushanka Kleinman, and was structured to address seven areas of interest within three categories. These categories include: "(1) public education--for the general public, children , and minorities; (2) donor criteria--both of cadaveric and live donors; and (3) professional education--of individual medical professionals and those who develop policies within the hospitals and health care environment."

I think that this program was well designed considering the varied factors that effect organ donation. This multi-faceted program, and others like it, will glean the results necessary to restructure the current system of organ transplantation. It is not enough to focus on the factors that influence the system individually. It is necessary to examine all applicable factors and to determine how they function in relation to one anther. Only then can the system be properly manipulated.

This article contained neither footnotes, nor a bibliography.


Orly Hazony, Increasing the Supply of Cadaver Organs For Transplantation: Recognizing that the Real Problem is Psychological Not Legal, 3 Health Matrix 219 (1993).

As all the other articles cited in this bibliography, Hazony's article on organ transplantation emphasizes the fact that the organ procurement system in the United States is failing. However, Hazony claims that the solution is not in legislation. Laws cannot solve the problems we experience with organ procurement and transplantation because the problem is not legal. Hazony contends that the problem is psychological. Thus the key to solving this psychological problem is to address the personal issues that surround organ donation. This includes educating patients and health care providers on the social aspects of the process. If individuals are not comfortable with the issue of organ procurement they cannot be expected to take part in the process. He agrees with other authors in this bibliography who cite distrust for the health care system as a main factor discouraging minorities from donating organs. Hazony stresses the need for grassroots programs which educate individuals on organ donation. He especially advocates these programs for minority populations who are often left in the dark regarding this issue.

I agree with the observations made by Hazony. The system of organ donation is failing us. We have always relied on this system which emphasizes legal action and legislative policy, so it is likely that a new method should be employed. I do not think that legal actions should be avoided altogether, but why not go to the heart of the issue? People are not comfortable with the issue of organ donation because they do not trust the health care system. This is obvious when one analyzes minority populations which are known for distrust of the system. The only way to fix the problem is to step into the shoes of the members of our society. Once their concerns and apprehensions are laid to rest they will begin to donate organs at a higher frequency, and we can once again employ predominately legal tactics to ensure equity. Until officials acknowledge the needs of our divers society, this problem will never be resolved.

This article did not contain a bibliography, however, it supplied adequate footnotes.


Raja J. Khauli, Issues and Controversies Surrounding Organ Donation and Transplantation: The Need for Laws That Ensure Equity and Optimal Utility of a Scarce Resource, 27 Suffolk U. L. Rev. 1225 (1993).

This article argues that certain factors must be considered in order to create a system of organ donation and transplantation that is fair and equitable. First one must look at the various socioeconomic conditions surrounding the current controversy, and determine what means are best suited to resolve the situation. In considering these factors Khauli discusses the racial inequality in organ transplantation. Khauli states that factors other then antigen matching have been cited as attributing to lower rates of transplantation among African-Americans. These factors include: candidate unavailability when kidneys are offered; predominantly white donor pool; and lack of African-American donors.

I agree with Khauli that the system must be reevaluated considering current socioeconomic factors. However, I do not give credence to the factors he cites as attributing to inequality where African-Americans are concerned. Although I cannot dispute that the donor pool is predominantly white and that African-Americans do not donate at an acceptable level, I doubt that individuals are frequently unavailable when they are informed that organs have been made available for them. I would like to have found out further information in this regard. All in all, no matter what the disparity is attributed to I believe the main cause is antigen matching. For this reason, the system must be modified where this practice is concerned.

This article did not contain a bibliography, however, it supplied adequate 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 seeks to remedy the problems that accompany organ donation and transplantation through an innovative approach. The author seeks to create a causes of action which require members of the medical profession to avoid issues of liability by fully recognizing and respecting the rights of organ donors, and organ recipients. One of the causes of action that the author highlights is an action to allow recovery of damages by hospitals against a decedent organ donor's family where the family members intervene in the organ procurement process. Punitive damages would be available when there is a showing that the interference by the next of kin resulted from racist or other prejudiced motives.

I do not think that this is a feasible plan. Although it may not be precluded under current law, it would be vehemently opposed by many. Also the statement about awarding punitive damages where objections are based on racist or prejudiced motives is directed against racial and ethnic minorities who often seek to donate their organs only to members of the same race. When these parties find out that the race of the recipient cannot be promised, some decide not to follow through with the donation. This is an innovative approach, but it raises too many issues, and would likely prevent people from showing interest in donating their organs for fear of potential liability should they change their mind.

This article did not contain a bibliography, however, it supplied adequate footnotes.


Bernard M. Dickens,Living Tissue and Organ Donors and Property Law: More on Moore, 8 J. Contemp. Health L. & Pol'y 73 (1992).

This article begins with a discussion of Moore v. Regents of the University of California. 793 P.2d 497 (Cal. 1990), cert. denied, 111 S. Ct. 1388 (1991). The case involved a patient whose physician used his cells to create a patented cell line. The cell line was used to produce biotechnological products. It was estimated that the cell line could be marketed in such a way as to gross over three billion dollars in profits. Moore's physician, and the other inventors of the cell line, negotiated for 75,000 shares in stock, and at least $330,000. The problem is that the analysis of Moore's cells was taking place unbeknownst to him, and he was denied the any share of the potential profits because he had no property interest in his cells after the physician had procured them. However, despite this fact, the Supreme Court of California refused to extend Moore's property rights to the cells that the physicians procured. They reasoned that he clearly did not intend to retain an ownership interest in light of the fact that he did not expect to get the cells back.

Because no property interest is extended to organs or tissue removed from a patient, this may create problems in the implementation of policies which attempt to boost organ donation. Many African-Americans would be more likely to donate their organs if they could be assured that their organs and tissue would be donated to an African-American recipient. These types of programs would not be allowed under the reasoning expressed in Moore, considering that the patient loses all interest in his or her organs after voluntary donation. This might discourage organ donation, and adversely impact the health care system.

This article presents an issue which is crucial to the practice of organ donation. I think that the health care system should promote patient autonomy. Telling an individual that he or she has no interest in his or her organs creates a sense that patient autonomy is being inhibited. Ideally, I think that patients should be allowed to put stipulations on their potential recipients, however, I do not believe that this is administratively feasible. It would be difficult, if not impossible, for hospitals to keep track of who patients desire their organs to go to or where patients desire their organs to go after death. Reading a little further into the issue, I question whether these programs are necessary. With the requirement of antigen matching, it is quite likely that all anatomical gifts will be received by someone of the same or similar genetic composition as the donor.

This article did not contain a bibliography, however, it supplied adequate footnotes.


Paul J. Hauptman, Medical Progress: Procurement and Allocation of Solid Organs for Transplantation, New England Journal of Medicine, Feb. 6, 1997.

This article explains some of the methods used in the procurement of solid organs. Some of these methods include donations from: (1) dead or cadaveric sources; (2) living and related donors; (3) living unrelated donors; (4) asystolic cadaveric donors; and other means. However, despite these advances in organ procurement the number of candidates for organ transplants increase each day. No matter what new methods are employed the gap between the number of available organs and the number of patients awaiting transplants seems to widen.

This article presented amazing information about medical advances. The article described the sources of and the methods currently used to procure organs. Ironically, we have come to an age where organs can be reused, where a wider age range of candidates are be considered as donors, and we still cannot meet the need. Maybe some of the money that is being spent on medical research should be shifted, and filtered into programs which educate individuals on organ donation. Better yet the money should be used to research alternatives to the antigen matching system.

The article maintains that the present system must be changed in order to fully serve the needs of African Americans. One interesting fact the article revealed was that current donation policies have been previously amended such that the families of decedents will be able to designate a specific recipient for the organs of their family member. This may help encourage donation among members of minority groups who wish that their organs be given to an individual of their same race.

This article contains references and footnotes.


Organ Transplantation, 103 Harv. L. Rev. 1614 (1990).

This article discusses the current system of organ donation and transplantation. Although the author believes that the current system is not perfect, there is a strong belief that it is fair and acceptable. The author describes the two-tiered system of organ transplantation. During the first phase private transplant teams decide who will be placed on the many established waiting lists. During the second phase the organs are transplanted to candidates selected from the respective lists based upon "medical criteria" (emphasis added). The authors object to the degree of subjectivity and discretion afforded to those influencing the first phase of the process, but had no qualms with a system that overlooks the needs of a segment of the population under the guise of "medical criteria." The authors also stated that the system, if it was mandated and considered state action, would survive constitutional challenges based on equal protection and due process.

I think that the author is supports the program based on the desire to make efficient use of the system. However the author does say that in certain instances other factors should be considered. This statement reveals that the author believes the system to be unjust. Where the system is not working it should not be tolerated for lack of an alternative. To the contrary, the system should be modified in the interest of justice.

This article contained no bibliography, but provided extensive footnotes.


Roger W. Evans, The Potential Supply of Organ Donors: An Assessment of the Efficiency of Organ Procurement Efforts in the United States, Journal of the American Medical Association, Jan. 8, 1992.

This article sought to establish a geographic organ donor database. In order to do this the author had to turn to the vital statistics for the particular area in order to determine population based census information and modified based on the number of births and deaths. The researchers then subtracted the number of out-of-hospital deaths, age, or other such conditions which would deem a person unfit to qualify as a donor. Ultimately, the research concluded that many more organ donors are available then are being accessed. This result was consistent even though the exact size of the donor pool is debatable.

This information comes as no shock. Many people can potentially be organ donors but decide not to for personal, religious, or other reasons. The decision to donate organs is a choice, and should be left up to the individual, or the family of that individual upon his/her death. I do not believe that the author could have determined an accurate or precise size for the donor pool. Furthermore I do not believe the survey evidence provided in this article. Due to the current push to promote organ donation I believe that many individuals say that they would donate their organs only out of a desire to be viewed as politically correct. This is why, I do not trust survey data as to this issue. Organ donation is something that everyone knows that they should do, but that not everyone does. For this reason, people may answer these types of questions falsely, or change their mind in the face of personal considerations.

This article contained both a list of references and footnotes.


Robert Gaston, Racial Equity in Renal Transplantation: the Disparate Impact of HLA-Based Allocation, Journal of the American Medical Association, Sept. 15, 1993.

This article seeks to change the current system of organ donation. The article states that race should not be the sole factor impacting the restructure of the organ allocation process, and it is simplistic to argue that the only problem with the system is its racially slanted results. However, the article also explains that just as simplistic is the idea that a system based solely on producing the best genetic matches is a superior system. The fact that so many African-Americans suffer from end stage renal disease is an indication that the problem will not be going away any time soon, especially if the current system is retained.

This article is easy to follow and clear in its contentions. It focuses on the social factors surrounding the issue of organ transplantation. The article raised issues that were not indicated in

other articles, namely the fact that minorities are underrepresented on organ waiting lists, and that minority patients awaiting organs are often unable to maintain adequate communication with their physicians or are unable to travel to the transplant centers in a timely manner, thus forfeiting their opportunity to obtain their much needed transplants.

This article contained both a list of references and footnotes.


Barbara A. Noah, Racist Health Care, 48 Fla. L. Rev. 357 (1996).

In her article, Noah reviews racial disparities in the health care system. Noah limits her analysis to racism as it relates to the utilization of Medicare services, the lack of minority representation in clinical research studies, and the selection of organ transplant recipients. In regards to Medicare services, Noah explains that even where "insurance discrimination" is not an issue, the health care for African-Americans falls behind the heath care provided for White Americans. In regards to clinical research studies, many studies fail to include members of ethnic minorities and women in their biomedical research. Given the fact that pharmokinetic differences have been reported to transgress racial lines one cannot safely conclude that the effects reported by white male research subjects will be the same as those reported by women and members of minority groups. Where organ donation is concerned, Noah blames racial disparities on the requirement of antigen matching. Even though African-Americans have been donation organs much more frequently in recent years this will not solve the problem because African-Americans represent a disproportionately large percentage of patients with end stage renal disease(ESRD). Thus, although African-Americans should donate organs in order to ameliorate the current situation, but this in and of itself will not be enough. It is the duty of the United Network for Organ Sharing to find a system that can strike a balance between transplant efficacy and distributive justice.

Noah's arguments were quite convincing. She briefly, yet thoroughly defined the problems, and explained why the "obvious" solutions are not working. In regards to organ transplantation she "hit the nail on the head." Although many argue that increasing the number of African-American donors will remedy the current situation, Noah points out that this measure alone is not adequate due to the disproportionately large number of African-Americans with ESRD. Thus, although UNOS should be commended for their desire to promote efficacy in organ transplantation, the result, whether intended or not, adversely affects African-Americans. UNOS should act on this sound advice. Unless a more fair and equitable system is put into effect, the needs of African-American patients will not be met.

This article does not contain a bibliography, however, it supplied extensive footnotes.


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 her analysis of health care from a minority perspective, Randall attempts to identify the roots of the distrust which many members of ethnic minorities display toward the health care system. Randall focuses her analysis on the views and experiences of African-Americans, and concludes that the distrust is the direct result of slavery, segregation, and racism. These factors have led to the use of African-Americans in risky medical experimentation, the unwarranted sterilization of African-American women, the disparate health status of African-Americans in relation to their white counterparts, racial barriers in access to health care and medical treatment. Randall discusses a host of other issues including organ donation.

In regards to organ donation Randall argues that six antigen matching is an unnecessary practice considering that there are other allocation methods available which would lessen the disparity in the distribution of donated kidneys. Randall also explains the myths that haunt the African-American community in regards to organ donation, and the social factors that reduce their desire to donate. In general, Randall maintains that "European Americans" often overlook the needs and views African-Americans claiming that these views are not representative of society as a whole. This belief is held by bioethicists as well, who refuse to consider the views of African-Americans as they structure health policy and analyze medical issues that directly affect the African-American community. She argues that until these bioethicists and others involved in the health care delivery system acknowledge the needs of African-Americans, African-Americans will continue to distrust the health care system.

I agree with the views expressed by Randall in her article. Although I understand the rationale behind the preference for six antigen matching the fact that this preference has a disparate impact on minorities seems to be totally ignored. Likewise, little has been done to clear up the myths that surround organ donation in minority communities. One cannot expect African-Americans to eagerly participate in the health care system given the terrible obstacles that the system has presented to them. It is unfortunate that the views, and fears shared by certain members of society are so easily dismissed by members of the dominant classes, namely White Americans. There is no doubt that it will be difficult to cater to the diverse needs of all members of our society, but until an attempt is made to pursue some level of sensitivity toward African-Americans and other ethnic minorities they will continue to isolate themselves from the system, and thus their needs will remain unmet. However, a reciprocal duty falls on African-Americans. As a race, African-Americans must also work to solve the problems that they face. The effects of this health care problem do not effect White Americans. How then can we expect them to be moved to act in regards to a cause that does not effect them. African-Americans should act on their feelings of rage and injustice in hopes of moving the powers-that-be to act in their favor.

This article did not contain a bibliography, however, it supplied extensive footnotes.


Ian Ayers, Unequal Racial Access to Kidney Transplantation, 46 Vand. L. Rev. 805 (1993).

This article advocates laying to rest the current system of allocating kidneys for transplantation. The current system has resulted in unequal access to renal transplantation for African-Americans due to its heavy reliance on antigen matching. The authors propose a system which seeks to take more non-genetic factors into consideration, thus creating a more equitable system without compromising efficacy. The proposed system would: (1) eliminate points for patients with two or more mismatched antigens; (2) increase points for time spent on the waiting list; and (3) award points for patients with rare antigens.

I believe that the first and third measures have been recommended in the interest of efficacy, but the second measure is the one which most impresses me. This measure would help individuals who are often overlooked. This is a very important factor, and will be the most instrumental in getting organs for African-American recipients. I am not trained in medicine, so I cannot comment on the efficacy issues, however I think this program is on the right track. There is no reason to focus all energies on equal access to organs if the organs will be rejected by the patient. These organs are scarce commodities, and ensuring matches should be the goal. However, this goal should not be used as a shield to protect the system from attack when their actions are not in the best interests of justice.

This article did not contain a bibliography, however, it supplied extensive footnotes.


Stephen Bird, Why Buy an Inexpensive "Home Lawyer" Program? A Look at Quicken Family Lawyer Software, 13 NO. 14 Law. PC 8 (1996).

This article recommends the use of a computer program to prepare a variety of legal documents. However emphasis is placed on organ donation forms, refusal to donate forms, and amendments to, and revocations of, prior offers to donate organs. The programs are state specific, and provide users with general information about organ donation.

This article does not appear to be directly related to my issue at first glance. However, a close look at this article provides support for the hypothesis that members of minority groups do not donate organs at as high a level as whites because of a lack of adequate education on organ donation. Although this program may be helpful in serving certain members of our society, the individuals who need to use this service are probably not the individuals who own home computers, or who can afford specialized software. This statement should, by no means, be taken as an indication that members of minority groups cannot afford, or do not own personal computers. This is simply a statement indicating that those who own computers are more likely to have access to sources of information which would educate them on this issue. Thus the program serves as a tool for those who have already pondered the issue of organ donation. In order to solve the problems that we confront, it would be better serving to reach out to those who have not yet pondered or been exposed to the issues surrounding organ donation and transplantation.

This article did not contain a bibliography or footnotes.


Stephanie Crosse is a second year student at the University of Dayton School of Law. She graduated from the University of Texas (Austin, Texas) in Fall of 1995, with a Bachelor of Arts degree in Government. After obtaining her law degree, she hopes to pursue a career in family law or health care law.


1. Ann Klassen, "Women, Ethnic Groups Wait Longer for Liver Transplantation ," Medical Care. 5 March 1998.

2. Id.

3. 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).

4. Barbara A. Noah, Racist Health Care, 48 Fla. L. Rev. 357 (1996).

5. Id.

6. Id.

7. Statement of Donna E. Shalala, Secretary Department of Health and Human Services, March 26, 1998

8. Barbara A. Noah, Racist Health Care, 48 Fla. L. Rev. 357 (1996).

9. Author Unknown

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Professor Vernellia R. Randall
Institute on Race, Health Care and the Law
The University of Dayton School of Law
300 College Park 
Dayton, OH 45469-2772
Email: randall@udayton.edu


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