Organ transplantation is the process of replacing the damaged organ of one person with the functioning organ of a living or deceased donor. The first successful kidney transplant was performed in 1954 and since then over 700,000 transplants have been performed in the United States alone with about 30,000 transplants performed each year. Although this number may seem large, there are over 100,000 people in the United States on the organ transplant waiting list with an average of 20 people on the list dying each day. Considering only 54% of Americans are registered organ donors, most of these deaths are due to a scarcity of organ donation. There are a number of reasons for the shortage in organ donors ranging from ethical beliefs to a lack of knowledge on organ transplantation.
Two important factors that affect organ donation are religion and race. As a result of organ transplantation being a new medical breakthrough, a number of religions do not have a clear stance on their opinion of the procedure. This uncertainty decreases organ donation numbers because people will not donate if they believe it could be immoral. Religion is not the only factor that can lower donation rates. Lack of trust in health professionals, religious misconceptions and a lack of knowledge all play a role in the deficit of organ donors in minority populations. There are several suggestions on how to increase organ donation in both of these groups such as by informing congregations of their religion’s stance on organ donation, organ payment compensation and educating minorities on organ transplantation.
Religion is an important factor in whether people will donate or even accept organ transplants. Organ transplantation involves removing organs, from live or deceased donors, and putting them into another person’s body. There are many people who believe that the human body is sacred and removal of organs is disgracing the body. The opinions of religious leaders are revered with studies suggesting that people are more willing to donate organs if they anticipate the support of their religious community and a religious leader. Although not all members of a single religion hold the same views on organ transplantation, the majority’s sentiments greatly influences the rate of donations.
Christianity is split into a number of denominations, the majority of them support organ transplantation, Jehovah witness is an outlier which will be discussed later. It appears that in Christianity brain-dead donors are acceptable, differing from many other religions that categorize death to be when all systems no longer work including respiratory. Catholicism, the first Christian denomination, commends organ transplantation even saying that, “Organ donation after death is a noble and meritorious act and is to be encouraged as an expression of generous solidarity.”
Most other denominations including Protestants, Pentecostal, and Anglicans support or do not object to the act of organ donation. Even Christian Scientists, who tend to be against new-age medical treatments, have said, “organ donation and transplantation are seen as a personal choice” . The outcome of Christianity’s general acceptance for organ transplantation can be seen in the high organ donor rates in countries such as the “United States, France, England, Portugal, and Croatia” where majority of the population identifies as Christian.
In Judaism, there is no definite opinion on whether organ donation should be allowable. There are multiple factors in Judaism that would seem to deem organ transplantation as unacceptable. In Judaism, as well as in Islam, the body of the dead must be buried within 24 hours, delaying this process in order to harvest organs from the deceased would be seen as unacceptable. Also according to HODS “Desecration of the cadaver, for whatever reason is frowned upon as is the ‘receiving of any benefit from the dead” . Due to these factors it would seem that Judaism is against organ transplantation, however, the duty to save lives nullifies almost all other laws and thus organ donation can be seen as admissible.
There is controversy in allowing brain-dead organ donors differing greatly from Christianity, which allows such donations. In conventional Judaism a person is not considered dead until all of their functions, including heartbeats have ceased. Nevertheless, there are Jewish scholars that argue that brainstem death is considered death, allowing for this person to be a deceased organ donor. Due to Judaism’s unclear stance on organ transplant, “only about 10% of Israel [the only country where majority of the population is Jewish] are registered organ donors”
Similar to Judaism, there is no overall agreement of Islam’s position on organ donation. Much of the opposition to organ transplantation occurs because it is believed that “the human body dead or alive, is sacred and should be honored, thereby making it unlawful to tamper with, remove parts of, or dishonor the body in any way”. However, the Islamic Fiqh Academy has ruled it acceptable to donate organs as long as it is done to do more good than harm. Additionally, a study by Ersin Uskun found that 72% of Islamic leaders believe that organ donation does not violate Islamic beliefs although only half of these leaders would donate their own organs after death. Even with this support many Muslims still do not agree with organ donation, this is evident in the low donation rates in Islamic countries. Live organ donation seems to be generally more accepted but deceased donation rates are as low as 13% in Iran and ~25% in Turkey, Saudi Arabia and Kuwait.
A reason deceased donor rates may be so low is because, at least in Turkey, the consent of the donors family is required. Many Muslims do not feel comfortable with organ donation and even if their relative was a live donor, the family may not allow the dead to be a deceased donor. Although Uksun’s study found that majority of leaders found donation does not violate Islamic beliefs, only a third of these leaders would allow their relatives to donate organs after death. Considering that majority of these leaders surveyed have stated their opinion is constantly sought by those with questions on organ donation , their unwillingness to donate their own or their relatives organs could greatly influence deceased donation rates. Another reason donation rates could be so low is because similar to Judaism, bodies are suppose to be buried within 24 hours and brain death donations are still controversial although many Islamic scholars believe it is acceptable.
While some religions have unclear stances on organ donation, there are some that are strongly against it. Jehovah witnesses, a denomination of Christianity, only recently became allowed to undergo transplantation. In the 1960’s the group stated that organ transplant is similar to cannibalism because a person is are allowing another human’s flesh inside of their own. This comment has since been retracted, and the choice of transplantation is now left to the individual. However, Jehovah witnesses do not allow blood transfusions making organ transplantation extremely difficult. During organ donation, this refusal of blood transfusions could lead to a preventable death and loss of the organ. Although it is difficult these procedures can be done especially because under anesthesia, the patient cannot refuse the transfusions. The problem is when the procedure is completed; if there are complications the patient can refuse the life saving blood transfusion making it difficult to perform transplantation on these patients. This explains why only a small amount of Jehovah witnesses undergo transplantation.
A religion that completely opposes organ transplantation is Shinto. Shinto is mainly practiced in Japan and has multiple factors that disagree with organ transplantation such as the body being unharmed, and that the dead body is impure so it should not be touched. Thus, organ transplantation is almost impossible because removing the organs would disfigure the body of the donor and inserting the organs would involve harm to the recipient. Additionally, Shinto believes that the dead person’s soul goes into another world and preserving the body as a whole is crucial or the soul will be unhappy. Due to these beliefs, organ transplant rates in Japan are extremely low ranging around 300 transplants and 100 donations per year.
Religion has great implications on a person’s willingness to become an organ donor but so does race. Minorities account for 54% of people on the organ transplantation list but only make up 40% of the donors. Although a person can receive an organ from anyone regardless of race, “better matches for HLA occur in people with the same ethnicities”. Thus, racial disparities in organ donations lead to minorities having longer wait time for organs than Caucasians. There are multiple factors that account for the disproportional amount of organ donations among minorities including: a distrust of the healthcare system, religious beliefs, disparities between donation rates in certain UNOS regions and lack of knowledge.
As noted above one reason for the relatively low donation rates among African Americans is distrust in the health care system. There is good reason for this. During slavery African Americans slaves were subjected to harsh medical experiments that were often done without anesthesia. Vesicovaginal fistulas performed on slaves by the “father” of gynecology Dr. Marion Sims are an example of this type of experimentation. Some may argue that because most of these slaves did not die, and the experiments were successful that it is ok. However, Dr. Sims also experimented on newborn slaves with Trismus nascentium using awls to realign their skulls resulting in a 100% fatality rate. Instead of taking responsibility for these deaths, he blamed the deaths on the mothers of the children.
This type of abuse continued for hundreds of years and did not end with slavery. African Americans have been subject to controversial medical experiments even in the twentieth century such as the Tuskegee experiment. The Tuskegee experiment is when the U.S. department of public health examined African American men with syphilis for four decades in order to learn more about its’ effects. They never revealed to these men that they had syphilis or gave them a known cure for the disease.
This type of mistreatment and racism has led to a general distrust and fear among African Americans when it comes to seeking medical care. This fear has caused huge problems for the African American community as blacks have higher rates of hypertension, diabetes and stroke when compared to their white counterparts. Although other factors, such as poverty, contribute to these rates a distrust of medical professionals is also a reason. Due to these high rates of diseases such as diabetes and hypertension, African Americans are represented at relatively higher rates on organ transplant lists but represent much lower rates for donations. As a result of their distrust with health systems, many African Americans also fear that registering as an organ donor would lead to a premature death because health care professionals would not save them in order to use their organs.
Another reason for the low donation rates among minorities stem from religious beliefs. As mentioned earlier, most Christian denominations agree with organ transplantation and Catholics even revere it as a “noble act”. However, even though most African Americans are Christian and most Hispanics are Roman Catholic , there is still a general belief in these populations that organ donation would somehow prevent them from entering into Heaven. The evidence is clear in Hispanic Americans whom are 60% less likely to be registered organ donors than their white counterparts. Robinson et al have found that these religious beliefs are “central to shaping donation attitudes, intentions, and behavior”. Thus, religious beliefs of these groups and their lack of knowledge on the church’s stance on organ transplantation are an explanation for the low donor rates.
Reasons for racial disparities in organ transplant are not all due to personal beliefs; some are due to where a person lives. UNOS splits the United States into 12 different regions, and people on transplant lists are eligible for organs in all states in their region. Minority groups tend to live in similar areas, for example African Americans predominately live in the southern states . Due to this distribution, there are disparities in certain UNOS regions when it comes to minorities. According to Saunders et al, there is:
significant variation between UNOS regions in the proportion of African Americans and Hispanics who receive liver transplants. Additionally, there were racial and ethnic disparities in liver transplant for Asians and Hispanics within particular UNOS regions.
This data illustrates that there is racial disparities in certain regions due to the large amount of the ethnicity in the area. With a large group there will be more people whom need organ transplants but because of the reasons listed above, minority groups tend not to donate organs leading to this disparity.
Finally, a reason that minority groups are less likely to donate is due to a lack of knowledge. Many people are uninformed or misinformed about organ transplantation. They believe myths and misconceptions about organ transplantation and believe that becoming an organ donor can lead them to premature death or not getting into heaven. A twitter poll of about fifty people was conducted to see how millennial viewed organ transplantations, 96% of these participants were minorities. Results illustrated that while 96% of the participants agreed with organ donation and majority did not believe it was against their religion, but only 39% of them were registered organ donors. Reasons given for not registering as an organ donor were mainly due to a fear that it would lead to a premature death. Thus, even though minorities know the importance of organ transplantation they do not register as donors due to the reasons mentioned above.
With all these explanations for how religion and race affect organ transplantation, there have been suggestions on how to increase registered donor amounts. Aforementioned in Christianity, besides Jehovah witnesses, organ transplantation is tolerated and in Catholicism it is advocated. In spite of this there are still people, many in the African American and Hispanic community, who believe that becoming an organ donor would somehow jeopardize their entry into Heaven. In order to alleviate this misconception, Salim et al suggested that having religious leaders teach about organ donation and the churches stance on it during church would help increase organ donations. Salim et al’s survey found that “only 5.5% of pre-intervention respondents learned about organ donation at church”. If Christian religious leaders were more vocal about the support of organ transplantation by the church more people, especially minorities would likely become donors considering that religion is particularly important in these communities.
In Judaism, organ transplantation is neither directly condemned nor revered. There are scriptures in the Torah condemning acts related organ transplantation but the duty to save lives seems to negate these rules. Regardless Israel still has very low donation rates compared to other countries and in 2008, created a law to fix this problem. In order to increase donation numbers, Israel created a unique law that gives registered donors and their families’ priority if they themselves are ever on the organ transplant list.
The law appears to be working and has led to a slight increase in organ donation but it has not come without opposition. Some extremely orthodox Jews are so against the law they have created anti-donation cards stating that their organs should not be removed for any reason. Due to the issue with brainstem death, donors can choose whether to allow organs to be taken when brain dead or only after natural heart cessation. Allowing this difference likely increased the amount of donors. Although this law led to a slight increase, in order to further increase donations Jewish leaders should begin openly supporting organ transplants and talking about it in synagogues. As earlier mentioned, people would be more willing to donate if they feel they have the approval of their religion and religious leader.
Islam is similar to Judaism with its stance on organ transplantation. There are scriptures eluding that organ transplantation is wrong because there should be no tampering with the body in anyway. However, the Islamic Fiqh Academy has deemed organ transplantation as acceptable and in a survey it was found that most Islamic officials agree with organ transplantation. Even with the approval from religious leaders most Islamic countries have very low donation rates especially when it comes to deceased donations. Islamic leaders speaking to members about organ donation and informing them that it is acceptable in their religion could increase donation rates. Additionally an increase would occur if Islamic leaders showed their support by becoming registered organ donors themselves. Considering only half of the leaders surveyed said they would donate their own organs after death makes it difficult to convince others that being an organ donor is a morally correct decision.
Another innovative way to increase organ donations is by paying donors. Iran, an Islamic country, is one of the few countries that pay kidney donors for their organs. The law was implemented because for the twenty years following Iran’s first kidney transplant only one hundred more of these transplants were performed. In an attempt to increase the amount of donations, Iran allowed non-related donors to donate organs and rewarded these donors with free health insurance for their donations. These donors also often receive a cash compensation of about $3500 from the recipient or a charity. Subsequently the amount of kidney transplants in the country doubled as a result of the law. In order to prevent non-citizens traveling to Iran for transplants, only Iranians can receive transplants in Iran. Additionally in order to prevent refugees from being taken advantage of due to their status, they are allowed to receive transplants but can only donate to those of their same ethnicity.
By analyzing the good that came as a result from Iran’s compensation for organ donation, it seems that other countries should also establish payment systems in order to increase their organ transplant numbers. The idea of a recipient getting the gift of a longer life and the donor being able to be compensated appears to be a good idea. This system works well in Iran where it is regulated and rules are in place to prevent the poor from being abused. Consequently, this plan could not work in all countries.
In countries such as Pakistan and India, the impoverished are often persuaded to donate their organs in order to pay off debts with the delusion that doing so will provide them with a better life. However, most of these donors remained in poverty partially due to health problems as a result of the transplant, which prevent them from being able to work. The less fortunate in these countries are not protected from being used for their organs and are left in a worse predicament then before. Additionally, due to the unregulated system in these countries, the wealthy recipients paying for organs could potentially contract diseases during the surgery. Those paying for organs in these countries risk the chance of contracting life-threatening infections or diseases such as hepatitis and HIV. Thus, Iran’s compensation system is a good idea but only in countries where the system would be regulated, observed carefully and the exploitation of the poor would be prevented.
Jehovah witness, a branch of Christianity, do not accept blood transfusions making organ transplants difficult but not impossible. Nonetheless if a complication arises where the patient requires a transfusion, the patient and the organ would be lost. Another person on the transplant list could have received the organ but instead because of the patients’ religious views, two lives will be lost. Increasing organ transplantation in Jehovah witnesses would be strenuous because of their view on blood transfusion, a potentially life saving process. Bramstedt has suggested allowing Jehovah witnesses to only accept from donors of the same faith. This suggestion was made because a recipient has a lower chance of dying if they accept blood transfusions. Allowing Jehovah witnesses to accept organs would take away the chance for someone else to get one who could receive transfusions and potentially live longer. The main problem with this suggestion is what separates the Jehovah witness from any other high-risk patient. If a separate list were made for these types of patients then a separate list would need to be made for all high-risk patients, shrinking the already limited number of donors. Consequently, the only way to increase transplantation in the Jehovah witness population is to find alternatives to blood transfusions.
Comparable to religion, race also has a great influence on organ donation rates. There is distrust in the African-American community as a result of countless abuses forced upon them by medical processionals. From Henrietta Lacks whose cells were harvested without consent to the Tuskegee experiment mentioned earlier, medical professionals have a history of exploiting African Americans and other minorities. This distrust contributes to the low number of organ donors in the minority groups.
One way to increase organ donation rates in the African American community is to increase the amount of African American doctors. African Americans tend to feel more comfortable with healthcare professionals of the same race. If a person trusts their health care professional, they are more likely to listen to their advice such as about the importance of organ donation. In order to increase African-American representation in the healthcare community, affirmative action must be continued. Additionally, children in disadvantaged areas must be encouraged to pursue their education and stay away from the dangerous distractions that afflict their communities. Lastly, a way to increase the trust between African Americans and their health care providers is for providers to treat patients with respect and genuinely listening to concerns instead of becoming agitated by their justifiable distrust.
Finally, awareness can be used as a powerful tool to increase organ donation rates. The “Minority Organ Tissue Transplant Education Program” (MOTTEP) is an organization designed to increase organ donations in minorities. MOTTEP has set up programs all around the United States where they use various methods to teach the public about organ transplantation such as teen summits, partnerships with faith-based organizations and personal communication with residents in the community. These efforts have led to an increase in organ donors in these areas. MOTTEP of Tennessee, for example, reaches over 300,000 people through media campaigns and has contributed to a rise in organ donations among the African-American community. Additionally, individuals associated with MOTTEP have significantly increased donation rates such as Tony Sagayadoro who through educational outreach increased the Filipino community donor rate from 3% in 1995 to 70% in 2006. MOTTEP and organization like it prove that increasing knowledge about organ transplantation, especially in minority communities, increases donor rates.
Religion and race both have significant influence on whether or not a person is willing to be an organ donor. While most religions have no direct condemnation toward organ transplantation, there are people who believe that it can prevent them from getting into the afterlife they wish to live. When it comes to race, minorities face a large disparity between organ donations and the amount of people who need organs for a wide array of reasons such as mistrust in medical professionals by minority populations. In order to increase donation rates religious leaders should inform congregations on their religions stance on the procedure, more regulated payment compensation system should be put in place and minority groups should be educated on the topic.