There is an urgent need to increase the number of organ donors from
black and minority ethnic (BME) groups in countries with a strong
tradition of immigration, such as the UK, USA, Canada and the
Netherlands, in order to tackle inequalities in access and waiting times.
That is the key finding of a research paper on ethnicity and
transplants, published by the Journal of Renal Care in a free
online supplement that includes 15 studies on different aspects of
diabetes and kidney disease.
“BME groups are disproportionately affected by kidney problems for a
number of reasons, including higher levels of Type 2 diabetes and high
blood pressure, which are major causes of end-stage kidney disease” says
Professor Gurch Randhawa, Director of the Institute for Health Research
at the University of Bedfordshire, UK, and an expert in health diversity
and transplant issues.
“Despite this higher than average demand for transplants, 69% of BME
families in the UK refuse consent for organ donation, twice as many as
the 35% of white families. This underlines the need for greater
engagement with BME communities to increase awareness and donations and
prevent the conditions that lead to organ failure.
“This large shortfall in suitable organs can mean that BME patients can
wait much longer for transplants - and are more likely to die waiting -
because donations need to be matched, as far as possible, for tissue
types and blood groups. For example a significant proportion of South
Asian patients are blood group B, unlike most donors, and South Asians
and African-Caribbean patients can have different tissue types to white
patients, who make up the majority of organ donors.”
Analysis of the latest detailed UK transplant figures (2008) shows that:
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Approximately 8,000 people in the UK are on the transplant waiting
list - the majority are waiting for kidney transplants, but
substantial numbers are also waiting for heart, lung and liver
transplants.
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One in five people waiting for transplants are from the
African-Caribbean and South Asian communities.
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14% of people waiting for a kidney transplant are South Asian, despite
the fact that they only comprise 4% of the UK population and more than
7% are African-Caribbean, even though they only make up 2% of the
population.
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South Asian people are also disproportionately represented in people
waiting for liver transplants, making up 10% of the liver transplant
list. This is because viral hepatitis, which can lead to liver damage
and liver failure, is more prevalent in South Asian populations.
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Only 1% of the people on the UK’s voluntary Organ Donor Register are
South Asian and 0.3% are African-Caribbean. And only 1.2% of people
who donate their kidneys after death are South Asian and 0.7% are
African-Caribbean.
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South Asian and African-Caribbean people also wait twice as long as
white patients for a compatible kidney transplant, averaging 1,496,
1,389 and 722 days respectively.
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One in eight people who died in 2006 waiting for a transplant were of
South Asian or African-Caribbean origin.
“It is very clear from this current study that BME patients in the UK,
and a number of other countries, make up a relatively high percentage of
transplant candidates, but that this is not matched by organ donations
from the BME communities” says Professor Randhawa.
“Due to differences in tissue types and blood groups this means that
many BME transplant patients face a much longer wait than white
patients, who can be more easily matched with donated organs.
“The development of community-based organ donor campaigns is a recent UK
development that has the potential to offer a more meaningful route to
public engagement. Such initiatives may also provide opportunities for
shared learning and information exchange with other countries that are
grappling with inequalities in transplantation.
“What is very clear from our study is that members of the BME
communities need to be more aware of the need for organ donations and
that policy and resource initiatives are essential to tackle
inequalities in this vital area of healthcare.”
The supplement - Diabetes and renal disease: two diseases one person -
can be accessed free online at: http://onlinelibrary.wiley.com/doi/10.1111/jorc.2012.38.issue-s1/issuetoc
Subjects covered by the studies include: changing trends, pregnancy,
foot care, dietary management, exercise and quality of life. The papers
aim to help promote better cohesive disease management for the benefit
of both patients and carers.
