During the 15 years I have been involved in kidney transplantation, the question I have most often been asked is: "Why do blacks donate kidneys so infrequently?"
Blacks in the District should have a particular interest in the problems of treating kidney disease.
The District has the highest incidence of renal disease in the United States (299 cases per million), two to three times the incidence of Virginia and Maryland.
End stage renal disease is more prevalent in the black population than in any other racial group. Yet in this area blacks receive fewer kidney transplants than whites, and they generally do less well after transplant operations than do whites.
A Gallup poll in 1983 revealed that, while 27 percent of whites are willing to donate organs after death, only 10 percent of blacks are willing. Between January 1974 and January 1984, 80 percent of the recently deceased kidney donors at the Howard University Hospital Transplant Center were non-black.
In an effort to understand black attitudes toward kidney donation, a group of colleagues from the Howard Transplant Center undertook a research project, the results of which were published in 1982.
We interviewed 40 black men and women for the study and found the most common reasons for reluctance to donate kidneys were:
* a lack of information about kidney transplantation;
* religious fears (superstitions);
* distrust of the medical community;
* fear of premature death; and
* racism (blacks would prefer giving their kidneys to other blacks).
These findings made it possible for us to understand what had to be done to remove some obstacles to black donation. We concluded that a grass roots, face-to-face approach most likely would help us make a larger segment of the black community aware of what transplantation and the "Gift of Life" concept really mean.
Under the auspices of the National Kidney Foundation of the District of Columbia, the D.C. Organ Donor Project was formed in the summer of 1982. This pilot project began in Ward 5 under the leadership of Councilman William Spaulding and many other dedicated community residents. Under their guidance, programs and activities were established, including an expert speakers' list, slide and videotape presentations and a new curriculum on kidney disease, which has recently been included in the District's public school system.
Another element of the Organ Donor Project involves an education program through the D.C. Motor Vehicle Administration. Drivers seeking licenses are given information on the transplant program and organ donor cards. Licenses may be stamped on the spot for those wishing to be classified as an organ donor.
Since the program began in the fall of 1982, the number of people signing organ donor cards has increased from 25 a month to the current level of 600 a month.
In addition, a recent luncheon held at Howard University Hospital attracted a large group of religious leaders who have volunteered to help us inform black church members of the need for black organ donors.
We have also included various civic and social groups, including sororities, fraternities, Advisory Neighborhood Councils and funeral directors, in our attempts to increase the number of black donors.
Why is this effort so important?
After death, organs and tissues may be left behind and used to keep others alive. This "Gift of Life" can bring solace to the grieving family and a new lease on life to patients waiting for an organ (or tissues) to bring them from the brink of death.
But this gift can occur only if the family of the recently dead gives permission. Signing an organ donor card should be accompanied by a family discussion on the matter, so that prior to a death, each family member is made aware of how the others feel about this matter.
Such a discussion will reduce the chances of family members reacting with anger or hostility toward members of the transplant team who must visit and officially ask for the organ upon the donor's death.
The unique correlation between kidney disease and blacks has led us to schedule the First International Symposium on Renal Failure in Blacks for April 28 to 30 at the Washington Hilton hotel. The purpose of the symposium is to allow national and international renal experts to look at all the data available on this subject and to propose solutions.
What can blacks do? They can have annual blood pressure checks, so an early diagnosis of high blood pressure (hypertension) can be made and early treatment can be received. They can also become better informed about the "Gift of Life" concept and have family meetings to strongly consider donating organs after death.
The adoption of these recommendations will result in a decrease in the incidence of renal disease, since the leading cause of renal disease in blacks is hypertension. This silent, unrecognized killer produces renal failure in blacks 17 times more often than in whites.
At the same time, increasing the number of black organ donors may result in an improved success rate in black recipients of transplants from recently deceased persons.
It is clear that the black community can play a major role in elucidating and, perhaps, eradicating these serious medical problems.