Inequities in Organ Procurement Across the Nation

The COVID-19 pandemic is exacerbating the need for organs now and creating an urgent health equity issue, as communities of color are disproportionately impacted by the failures of the current organ donation system and the effects of COVID-19.
Bipartisan/Bicameral Congressional Leaders

Patients of color are far more likely to need an organ transplant than white Americans as a result of inferior service from OPOs

OPOs are less likely to respond to donation cases involving patients of color versus white patients, and have been shown to spend less time with these families and to provide less compassionate service. This leads to fewer lifesaving organs available for recipients of color - and the COVID-19 pandemic is only exacerbating these disparities.

Likelihood of kidney failure compared to white Americans in the U.S. by race

Hispanic AmericansBlack AmericansNative Americans
1.53x4x

Likelihood to have heptacellular carinoma compared to white Americans in the U.S.

Asian
American
4x

How this plays out during the organ procurement process

1

Patients of color are less likely to be referred to the OPOs than white patients.

This results from differential OPO practices and resource allocation for communities of color, including that OPOs spend fewer resources on hospital development in communities that serve patients of color, and sometimes even as as the result of specific “guidance by OPOs to not call on specific circumstances to avoid reporting on cases when the OPO believes donation is unlikely [overwhelmingly more commonly for patients of color].”

2

OPOs are less likely to respond to donation referrals for patients of color versus white patients.

One comparison study that looked at differences in organ donor experiences found Black families were “less likely to have spoken to an organ procurement organization representative,” with previous research concluding “[t]he odds that a family of a White patient was approached for donation were nearly twice those for a family of an African American.”

Dr. Ken Moritsugu, Former U.S. Surgeon General: “Often, misallocation of OPO resources means OPOs do not respond to all donation cases, or do not properly train and support their frontline staff. The impact of this, unsurprisingly, falls disproportionately on families of color.”

3

OPOs provide less complete and compassionate care to families of color versus white families

When OPOs do follow up with the families of patients of color, the quality of the interaction is often inadequate. A study comparing experiences between Black donor families and white donor families found Black people experienced “less complete discussions about the possibility of organ donation.”

Another study found the most common reasons Black families declined to donate were that the OPO did not “give [them] enough time to discuss important issues… or respond to strong emotion with sensitivity and empathy.”

This is a missed opportunity, since families who spend more contact with OPOs are shown to be 3 times as likely to donate.

Voices for organ donation reform

"The organ donation crisis disproportionately hurts patients of color. Patients can’t wait; so the government shouldn’t either."
Alonzo Mourning
"The reality is that the U.S. organ donation system is broken.... Both donor families and patients of color who need an organ experience different treatments and a system deeply rooted in inequity."
Global Liver Institute
"We must confront the racial injustices in our organ transplantation system as a matter of life and death."
Congresswoman Ayanna Pressley
Too often [OPOs] do not engage with our communities. They hire blindingly white work forces, and seem completely unwilling or unable to adopt culturally competant practices.
Ben Jealous, past president of NAACP