Strategies to facilitate organ donation among African Americans.

The greatest challenge for transplantation is the significant disparity in the number of organs available relative to the demand. African Americans in particular are disproportionately represented on the national transplantwaiting list for amyriad of reasons. Although accounting for merely 13% of the national population (1), African Americans comprise 30% of the 123,000 waitlist candidates (2). The need among African Americans is considerably high because the incidence rate of ESRD is 3.4 times greater than that among Caucasians (3). This disparity is exacerbated by the disproportionate effect of certain health conditions, such as diabetes, hypertension, heart disease, and hepatitis, which increase the necessity for a transplant. When putting this in perspective, an astounding 94% of the African Americans on the waitlist are specifically awaiting a life-enhancing kidney transplant. African Americans are also overrepresented among those inneedoforganspartlybecauseof thedifficulty in finding well-matched donors when compared with other racial/ethnic groups (4). This underrepresentation of African Americans in the donor pool speaks to the necessity of greater commitment to organ and tissue donation among African Americans (5). However, numerous barriers exist, and negative attitudes toward donation play a prominent role in the lack of donor registration (6,7). In this issue of CJASN, Locke et al. identify and prioritize strategies for increasing organ donation willingness and ultimately donor rates among African Americans (8). This thoughtfully designed study uses the novel formative research methodology of nominal group technique. This strategy is designed to stimulate the generation of ideas and gives guidance in the creative productivity of group discussion. In the approach taken by the authors of this study, four nominal group technique panel interviews were convened comprised of local Birmingham parishioners and clergy representing a diverse pool of Christian denominations. Participants were posed with a question (“What would make it easier for people to decide to become organ donors?”) and individually taskedwith recording their responses, which were later discussed as a group, anonymously voted on, and prioritized. Panel discussions generated the following themes related to strategies for increasing organ donation among African Americans: provide more information about organ donation (including what is involved and how it helps others), better publicize the need for organ donation (including through the use of television advertisements, commercials, and seminars at work or school), and help overcome the lack of trust of the medical community. There is no doubt that addressing these themes are critical to intervention development and overall educational efforts within the African-American community; however, many of the strategies detailed are not new to the field of organ donation. Over the last three decades, colleagues have studiedways to influence and effectively alter themodifiable barriers associatedwith organ donation among ethnic minority groups and African Americans in particular (9). Studies indicate that African Americans tend to be less knowledgeable about donation and/or transplantation than other racial/ethnic groups (10). Research clearly suggests that knowledge and awareness of organ donation are associated with the expression of written donation intentions and willingness to discuss intentions with family (9). More specifically, our work (11) has identified the types of knowledge that are more influential (knowledge of transplant allocation system and knowing a waitlist candidate or recipient) and less influential (i.e., knowledge of statistics, registration process, medical suitability, a donor/donor family) than others in the donation decision-making process. However, increased knowledge alone does not fix the problem. Well-cited theories in the field of behavioral sciences and health education clearly indicate that knowledge is necessary but not sufficient for most types of health behavior change, including organ and tissue donation (12). Continuingwith the themeof limitedknowledgeand the necessity for additional information, the results of Locke et al. (8) suggest the use of mass media as an approach to address the need for donation. Given the persuasive presence of media in the United States, this outlet is a very powerful resource that has been used for minority-focused donation-related education. Multiple studies have used campaigns to promote and educate about the topic of donation among minority populations, with a main outcome of either donor registrationor familynotification (13). Inparticular,minoritytargeted campaigns using an interpersonal message have been shown to bemore successful than those focusing on the general population (13). The National Minority Organ/Tissue Transplant Education Program Rollins School of Public Health, Emory University, Atlanta, Georgia