Racial Differences Between Solid Organ Transplant Donors and Recipients in British Columbia 2005–2009

A previous study revealed that non-Caucasian residents of British Columbia, Canada, donated fewer organs compared with their demographic representation and racial group specific need (1). Based on this study, demographic groups with lower donation rates were specifically targeted by BC Transplant (formally the BC Transplant Society, an Agency of the Provincial Health Services Authority of the Ministry of Health) in public education and awareness campaigns in the ensuing decade. These campaigns included ethnic media exposure, prominent displays during large public ethnic health care forums, and distribution of pamphlets in ethnic languages. The main purpose of this follow-up study was to examine the effect of BC Transplant organ donation awareness campaigns on donation rates among non-Caucasian groups, in particular, Pacific Asians (i.e., those with origins from China, Taiwan, Japan, Korea, etc.) and Asians Indians (i.e., those with origins from India, Pakistan, etc.), the two largest non-European/Caucasian racial groups. In British Columbia, the Chinese community represents 10% of the population; together with the Southeast Asian groups, they constitute approximately 11%. South Asians constitute 6.4% of the British Columbia population (2006 Canadian Census; source: Statistics Canada). In this study, the BC Transplant database was reviewed with respect to the racial background of each deceased organ donor and transplant recipient for the two periods (1993–1997, the original study period, and 2005–2009). Statistical analysis consisted of both descriptive and analytical statistical tests using the Student t test. The alpha level of significance (i.e., P value) was set at 0.05 for a two-tailed test. Analytic statistical analysis was performed using the SPSS version 17 computer software package (SPSS Inc, Chicago, IL). In the 5-year period from 1993 to 1997, there were 243 deceased donors and 764 transplant recipients. In the second period, from 2005 to 2009, there were 184 deceased donors and 712 recipients. In both periods, Caucasians represented most donors (93% [n=228] and 89% [n=164] in the first and second periods, respectively), but they received proportionately fewer organs (73% [n=585] and 69% [n=496], respectively). Pacific Asians constituted 2.28% (n=7) of all donors in the first period and 4.34% (n=8) in the second, but they represented a higher percentage of all recipients, 14.26% (n=109) in the first period and 11.51% (n=82) in the second period. Asian Indians constituted 0.82% (n=2) and 1.08% (n=2) of all donors, and of all recipients, they represented 4.97% (n=38) and 8.28% (n=59) in the first and second periods, respectively. There was no significant change in the number of all donors between the two periods (184 vs. 243, P=0.78). Similarly, there was no significant change in donation rates by race category (P=0.08 for Caucasians, P=0.655 for Pacific Asians, and P=1.0 for Asian Indians). Our results revealed that, despite a targeted educational campaign, since the original study was published in 1999, there has been no significant difference in donation rates. These disappointing findings are in contrast to the American experience, where a remarkable improvement in donation rates among African and Hispanic Americans has been reported (2). Although our study suggests that non-Caucasian British Columbians, most notably Chinese and Asian Indians, are less likely to agree for possible organ donation, the exact reasons for this remained unclear. We note that similar observations have been made among Asians in the United States and United Kingdom (3, 4). Cheung et al. (3) concluded that Asian Americans, compared with Caucasians, expressed a weaker sense of general community obligation, a stronger concern about maintaining body integrity after death, a lower level of doctor trust, less positive attitudes toward organ donation, and less frequent possession of organ donor cards. However, before assuming that non-Caucasian British Columbians are resistant to change their attitude toward organ donation, it is also possible that “traditional” public education campaigns that proved to be successful in non-Asian communities are not equally effective in the Asian community, and consequently, a different tailored approach is needed when targeting this community. Our study has important future implications. Information about attitude and barriers to donation among non-Caucasian British Columbians is scarce, and future studies are needed. Furthermore, there is a need to adopt more culturally sensitive methods in delivering organ awareness campaigns. Data about all eligible deceased donors, including the racial background, the conversion rates, and reasons for refusal should be collected by BC Transplant in the future. In conclusion, despite targeted organ donation awareness campaigns over the ensuing decade, there was no change in donation patterns. The reasons for this will need to be explored if organ donation rates for non-Caucasian demographic groups are to improve. Majid Alsahafi 1 Linda Leung2 Nilufar Partovi3,4 John Yee5 Eric M. Yoshida1 1 Division of Gastroenterology University of British Columbia Vancouver British Columbia, Canada 2 Division of Cardiology University of British Columbia, Vancouver British Columbia, Canada 3 Department of Pharmacy Vancouver General Hospital, Vancouver British Columbia, Canada 4 BC Transplant Vancouver, British Columbia, Canada 5 Department of Surgery University of British Columbia, Vancouver British Columbia, Canada