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Keia L. Randolph
Professor Williams
ENG 1201
5 August 2020

Why do minorities refuse to be organ and tissue donors?

Through the altruistic gift of organ donation, minorities who register as organ and tissue

donors can provide more opportunities to help those awaiting a transplant; but according to the

statistics reported by Organdonor.gov, as of March 2020, minorities make up approximately 60%

of the transplant patients on waiting lists in the United States yet comprise less than 30% of the

donors. To make matters worse, there are not enough donations, in general, to satisfy the needs

of the donor population. 90% of Americans reportedly support organ donation, but only 60% are

signed up to donate. The inference is that 40% have no real appetite for this particular act of

kindness with 30% on the fence and could possibly be moved towards donation with some extra

coaxing. The huge discrepancy between the organ and tissue needs and the tangible support

provided specifically by minorities is cause for both concern and question. It puts the position

and stance of those transplant advocates, especially those who hail from minority groups, in

perspective. These groups, as well as some of the lone proponents from these minority groups,

continue to emphasize the importance of organ and tissue registration across all demographics

with a special focus on increasing participation within minorities communities. With the average

donor able to save up to eight lives through organ donation and up to 100 through tissue

donation, there is a great deal riding on changing the attitudes, beliefs, and understandings of

those prospective donors within communities of color across the United States

(Americantransplantfoundation.org).
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With all of this attention, why do minorities still refuse to be organ and tissue donors

when the likelihood that someone from their population of family and friends will find

themselves on the transplant list or even succumb before an alternate solution is found is higher

than normal? There are multiple reasons why minorities are apprehensive about providing the

“gift of life” to/for others. Some of the sources of concern and uneasiness stem from religious

beliefs, specifically as they relate to burial practices; preconceived notions as they pertain to the

desecration of the human body and the firm, non-religious stance regarding keeping the body in-

tact for burial purposes; consideration for the condition and previous abuse of the donor’s body

to include concern for the intake of such substances as drugs and alcohol; general ignorance

about the donation option and qualifying criteria; and the historical collaboration between the

medical community and minorities. and cultural barriers such as ethnic practices and status quo.

In addition, some transplants are halted as a result of the inconclusive terms left by the dead prior

to their time of death.

The move to motivate and inspire the masses of people who are of non-Caucasian descent

to donate is a sensible one considering the statistics on both the supply and demand sides of the

transplant equation; so it is imperative that the message and the efforts counter the perceptions,

some of which are rooted in fact, to create understanding, promote greater participation, and

increase the number of viable organs and tissue options in the overall donor pool. With this

paper, my intention is to lay out some of the more significant reasons for the discrepancy

between white and black donors and provide some suggestions and insights to not only help

support and provide a clearer perspective on the topic but improve the statistical variance

between what minorities have done in the past and are willing to do in the future in the area of

organ donation.
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Religious beliefs, especially surrounding burial practices, can be a key factor in donor

decision-making. At times, it is the firm conviction of the deceased prior to the point of death, or

the decision-makers left behind, that can sometimes stifle the chance for a successful donation.

For some, their God, or principal point of worship, is believed to frown upon the act of removing

pieces and parts of the physical being that weren’t originally intended for anyone else but the

original user. Some ministers openly express their disapproval and condemnation for donation

even though their organizations have often collectively enfranchised the individual with the

religious authorization to make their own decision and without concern for repercussion from a

higher power/authority. For the most part, and across most religious sects, donation is viewed as

an act of charity endorsed by most denominations and ultimately aligning with the approval of

their inspiration for worship. It has been suggested that those who are considering donation

discuss the option with a spiritual advisor who can address concerns and offer discernment

regarding the organization’s position regarding the matter. Discussions of this kind can need to

take place more often and could potentially encourage more people to share organs and tissues in

preparation for the moment when this opportunity arises.

Preconceived notions, as they relate to the desecration of the body, form the basis of firm

positions to keep the body intact for burial purposes. This is a choice that isn’t necessarily rooted

in the principles of religion, but it embraces the same rationale in one respect: the body must

remain in as close to its form, at the time of death, as possible. Cultural barriers, including ethnic

practices and routines, can be hindrances to donation. In some communities, like the African

American community, it is not an accepted practice or normal consideration. African Americans

accounted for 14.1% of organ donations in 2019 while Caucasians accounted for over 70%. The

Hispanic communities is almost a third of the US population, but only accounted for 12.1% of
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donations in 2019 (HRSA 2020). Gypsies, who do not practice a formalized religion, believe

that one year after death, the soul revisits it steps. Hence, the body must remain complete to

match the intact soul (kidney.org). This is just a general choice that has nurtured and pass long

via folklore, and it has little spiritual basis. The idea is to satisfy the desire of the family to keep

the body in its natural form. Those things, including ideas, relics, and behaviors passed down

from generation to generation can be challenged. The selling point can be framed in a discussion

that incorporates the concept of change as both a natural part of life and the act of donation as

more a matter of helping the family and the culture’s legacy than actually bringing it shame and

harm.

Donation Statistics
www.Organdonor.gov

Fig, 1. This chart shows the percentage of donors by race/ ethnicity (HRSA 2020)

Consideration for the impact of previous abuse of the body can also be a key determining

factor whether to proceed with the organ and tissue allocations. It is important to note that the

types of abuse that the human body can/does endure extends beyond the conventional ideas of

drug, alcohol, and substance abuse. In the age of dopamine seekers, people now incorporate
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extensive exercise to the extent of it detrimental impact on the body; and with more and more

calorically dense foods now on our shelves, poor eating habits are resulting in another unique

form of physical abuse: obesity. In this case of obesity, poor health can diminish the probability

of an unrestricted donation. The source of this problem is unhealthy food and the associated

intake habits that lead to issues that can destroy the functionalities of the body’s inner and outer

donation components.

Although the level and intensity of chemical addiction puts the body in greater jeopardy

of experiencing a traumatic event and therefore rendering the act of donating organs a moot

point, ultra-endurance and high intensity physical activities can wreak havoc on the body’s

transplantable internal organs and tissue as well. To offset these two pressing issues, there needs

to be more focus on efforts and a strong campaign to encourage young people, the larger

demographic in society today, within minority communities to exercise in moderation, eat

properly, and take good care of themselves throughout their lives with a two-fold benefit. This

would create a more viable donor pool; and it would, to some extent, minimize the need for

overall donations.

Ignorance about the donation option and the qualifying criteria can impair the judgement

of potential donors and their advocates. Fear can be a huge deterrent, even with regards to doing

what is possibly considered proper, correct, or right. There are many instances where potential

donors are not up to speed on the exact details of how their, or their loved ones, humanity will be

preserved during the procurement process. The depictions that distort their view and impact their

judgement about the contribution of organs and human tissue can be the derivative of a cinema

experience, a casual conversation with another uninformed person, or just not knowing and

understanding the facts. There are also many criteria that disqualify the all-wanting donor or
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qualify the donor who otherwise wouldn’t have pursued the option. Getting the facts is a key step

in the process. Today, organizations like the National Minority Organ Tissue Transplant

Education Program (MOTTEP), founded in 1991 by Professor Clive Callender, provide

educational opportunities to minorities to help specifically increase the minority organ and tissue

donor contributions (natlmottep.org 1). There are also several tissue and donor websites that

challenge myths, address concerns, and provide facts regarding all aspects of donation. They are

a tremendous guide for the unknowing and those looking to educate and convince others to think

about the donation as an option. Inconclusive terms set by the dead individual prior to time of

death leave the procurement process to chance. Signing up for organ donation at the local DMV

or on a donor website removes the ambiguity surrounding one’s choice, but many times, it can

become a point of contention for those left behind to make the choice, grieve their loss, and bury

their loved one. As a result, arguments and debates among family members might be settled by

funeral home directors who are often reluctant to participate in accommodating the donation

process or the organ procurement organization.

There mistrust of the healthcare system by minorities, especially the African American

community, has been longstanding. African Americans and Latinos have seen the impact of

medical experimentation that has been often carried out by affable Caucasian medical personnel

who have given them the impression that their concerns were focused on patient care when

ulterior motives centered around research. One of the most notable instances was the Tuskegee

Experiment in 1930 (Waldo & Sullivan 2000). In this experiment, researchers purposely misled

African American males diagnosed with syphilis into believing they were receiving free

healthcare screenings and treatment when, in fact, they were giving these patients aspirin,

placebos, and iron tonic water and leaving their illness untreated. Their degradation and deaths
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due to the infection seemed to have no bearing on the conscious of the facilitators and

practitioners involved. Other unethical experimentation on minorities includes the extensive

research conducted by Dr. J. Marion Sims, the father of modern gynecology, on African

American women. His research led to the development of several surgical techniques, and he

used these women as specimens for teaching. (Holland 1) These are just a couple of the more

infamous, immoral, and inhumane medical projects that minorities have experienced. This also

puts the onus on the medical community to do their due diligence to improve the faith and trust

of the black community towards the medical establishment. Doctors, nurses, and medical

technicians need to provide the comfort and build the trust through top notch care, bedside

manner, and improved medical outcomes for minorities. Hospitals and the public officials need

to take the lead in making this a requirement while establishing consequences for non-

compliance.

There is still some work to be done. Twenty people die each day waiting on an organ

transplant, and every ten minutes a new person is added to the transplant waiting list.

(organdonor.gov 2019) Many of us have friends and family members who are transplant

recipients of either donor tissue or organs. Obstacles such as provider limiting access to much

needed referral or increase wait times by taking longer to provide the referral. (Nonterah 3)

These acts have either prolonged their existence or vastly improved their quality.

The selfless act of donation, in any form, is revered in most societies; and it aligns with

even the most selfish of philosophies, unless you are follower of Ayn Rand. The offering will

sometimes have some bearing on the act. Clothing, jewelry, and other material assets are easier

to part with once their utility has diminished and their value is no longer considered high. Organ

and tissue donation are the exceptions and the complicated examples for any and every rule. The
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reasoning and rationality behind not providing another human with the gift of life is/has been the

subject and topic of much debate, and there are many positions to review and analyze for this

subject matter. Monetary incentives could help increase donation rates from everyone and help

save thousands of lives (Pence 5). In the end, the choice is not so black and white as the

difference between the outcome donation creates and the cost of human life, or better quality of

life, lost; but the subject of organ donation provides insight into the dimensions of logic used by

others to come to terms with their choice. Whether one agrees or disagrees, it is ultimately a

choice; and understanding the “why” could help to move more people from the middle of the

road or even away from the opposite side of approval.

Donation is imperative for some and a chance at improvement for others. It affords the

willing an opportunity to provide the gift of life. For those who choose to take proactive

measures, it ensures their commitment is firm and legally bound early enough and while he/she

is of sound mind and body. It has been apparent that leaving the choice to chance and the

discretion of others who could provide the decision that results in a less than desirable outcome,

for a recipient in waiting, is a strong possibility. In my experience with speaking to families

about organ and tissue donation, the conversation was much easier when I could tell them their

loved one had already made the decision to donate, by registering as an organ and tissue donor,

so that they would not have to guess what he or she may have wanted when the time came.

I had the opportunity to speak with Mrs. S. White about the subject and her choice to

donate. She was not a registered donor. Although she knows organ donation saves lives, she had

concerns about how she would look to her family after the donation process and felt the

“hospital” would not save her life if she was registered as an organ donor. By presenting the facts

and options to her, I was able to convince someone who was not a proponent of donation to
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commit to becoming an organ and tissue donor. She also obliged me and said she was going to

register as an organ donor. When I asked her what the most compelling part of my approach was,

she mentioned the fact that her faith had been the basis of her decision and the impression that

charity, which God sanctions, was the overarching idea and very persuasive.

In the end, the challenge for procurement agencies is to understand the apprehensions of

potential donors and meet them with facts, knowledge, and reasonable appeals that address their

rationality, their spirituality (as it applies), and their good nature. Some of these tactics were

outlined by me in this paper.

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Works Cited

American Transplant Foundation, “Common Myths and Concerns”, 25 July 2020,

www.americantransplantfoundation.org/about-transplant/facts-and-myths/

Callender, Clive O, and Patrice V Miles, “Minority Organ Donation: The Power of an Educated

Community” National Center for Biotechnology Information, 1 May 2011

www.ncbi.nlm.nih.gov/pmc/articles/PMC2861044/

Health Resources & Services Administration (HRSA), “Organ Donation Statistics”

Organdonor.gov, 1 June 2020 www.organdonor.gov/statistics-stories/statistics.html

Accessed 26 July 2020

Holland, Brynn. “The ‘Father of Modern Gynecology’ Performed Shocking Experience on

Slaves” 29 August 2017 www.history.com/news/the-father-of-modern-gynecology-

performed-shocking-experiments-on-slaves Accessed 10 July 2020

National Minority Organ Tissue Transplant Education Program (MOTTEP),

www.natlmottep.org/about Accessed 15 July 2020

Nonterah, Camilla. "Minorities face more obstacles to a lifesaving organ transplant." Gale

Opposing Viewpoints Online Collection, Gale, 2020. Gale In Context: Opposing

Viewpoints, https://link-gale-

com.sinclair.ohionet.org/apps/doc/SPSFAZ645042314/OVIC?

u=dayt30401&sid=OVIC&xid=ddfaeb9e. Accessed 4 Aug. 2020. Originally published as

"Minorities face more obstacles to a lifesaving organ transplant," The Conversation, 11

June 2019. Accessed 4 August 2020

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Pence, Gregory E. "Compensating People for Organ Donation Could Alleviate the Organ

Shortage." Organ Transplants, edited by James D. Torr, Greenhaven Press, 2003. At

Issue. Gale In Context: Opposing Viewpoints, www.link-gale-

com.sinclair.ohionet.org/apps/doc/EJ3010284206/OVIC?

u=dayt30401&sid=OVIC&xid=53250d92. Accessed 12 July 2020

"Tuskegee Experiment." Civil Rights in the United States, edited by Waldo E. Martin, Jr. and

Patricia Sullivan, Macmillan Reference USA, 2000. Gale In Context: Opposing

Viewpoints, www.://link-gale-com.sinclair.ohionet.org/apps/doc/BT2338231196/OVIC?

u=dayt30401&sid=OVIC&xid=9fdbd048 . Accessed 15 July 2020.

White, Stephanie, Personal Interview, 25 July 2020