The 57 Organ Procurement Organizations (OPOs) in the U.S. have come under scrutiny regarding their efficiency and distribution processes.

In compliance with new Medicare regulations, OPOs have publically released demographic data related to organ donation.

According to the Organ Procurement and Transplant Network, the industry’s trade group, there were 18,317 total organ donors in 2020.

Of these, 67.6% (12,378) were white and 12.9% (2,372) were Black. These ratios have remained relatively steady for several years.

At first glance, one would note that the rate of donation typically reflects ethnicity ratios from the last US Census, with 60.1% of the population being white and 13.4% Black.

One might conclude from this that OPOs are doing enough to represent ethnic minorities. However, this is not the case.

According to the U.S. Department of Health and Human Services, there are over 106,000 people on a solid organ transplant waiting list.

While Blacks make up less than 14% of the total U.S. population, they make up 28.5% of solid organ transplant candidates. Most notably, Blacks account for a third of the kidney transplant waiting list and 28% of the heart transplant list.

This should not be surprising as diabetes, renal failure and heart disease are well documented health risks among Black patients.

According to the Centers for Disease Control and Prevention, we see significant disparities between Black and white patients on several health conditions.

Black patients between 18-49 years of age are twice as likely to die of heart disease as whites, while 23% of middle-aged Blacks have diabetes compared to 14% of whites.

We are seeing these disparities show up at earlier ages, and patients who develop chronic diseases at younger ages are more likely to need a solid organ transplant.

As a result of these trends, Blacks accounted for 21.6% (8,414) of all organ transplants (39,036) in 2020, while whites accounted for 53.8% (20,997).

The rate of transplantation is disproportionate, as whites only make up 40.4% of the waiting list.

An immediate conclusion might be to say that the organ procurement process must inappropriately favor white patients. This is both true and false.

The process is more complicated than simple number crunching.

When looking at the total percentages of patients and donors, it is easy to forget that transplant patients have to be matched with donors in order to avoid transplant rejection.

The more similar biologically the donor is to the transplant patient, the higher the chance the transplant will be successful and avoid rejection.

While it is not always the case, most patients will match with someone of their ethnicity or, even better, a family member.

Whites have tended to donate organs at a higher rate, which accounts for the disproportionate amount of organ transplants for white patients due to the need to match organs with patients based on biological markers.

While Blacks donate organs at a rate similar to their percentage of the population, they are twice as likely to need a transplant due to the higher rate of health challenges noted above.

Thus, transplant centers would need Blacks to donate at a much higher rate to offset the disproportionate rate of white transplants.

OPOs, transplant centers and public health experts have been wrestling with this disparity for over a decade.

On one side, OPOs are being asked to step up and focus more on supporting and educating Black families in order to procure more organs that will match with Black patients.

This is a difficult sell when the rate of donation is close to the rate of the general population, and because there is often mistrust of the health care establishment in minority communities due to past injustices and abuses.

On the other side, public health experts need to look at reducing the percentage of Blacks who suffer from organ failure in the first place, focusing on the chronic diseases that ultimately lead to organ failure.

Emerging data has pointed to social determinants of health as leading factors in chronic diseases. Income, education, neighborhood and career options all have an impact upon general health.

For example, if you cannot afford or lack access to high quality foods, then you are forced to eat a high caloric diet filled with trans-fats and limited nutritional value. This often leads to diabetes and heart disease – and possibly the need for an organ transplant.

Most discussions of racial disparities in organ donation miss the point by ignoring the complexities and making OPOs a scapegoat.

This is shameful, as scapegoating makes the situation worse by shifting focus away from the need for an in-depth analysis of the circumstances that have created this larger societal issue.

We must seek to understand, and then work to address, the deeper inequities and injustices that have created the conditions in which Blacks need organ transplants at a higher rate than whites.

Addressing this health care crisis will require more than handing out blood pressure cuffs or glucose strips. It will need more than free clinics and brochures.

It will require us to target social and economic forces that created a high rate of chronic diseases in the first place.

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