Some of the challenges of encouraging organ donation among minority populations.

rgan donation and organ allocation remain important issues for patients awaiting transplantation in the United States. The disparity between the number of deceased donors and the number of patients awaiting transplantation continues to widen each year. The number of deceased donors in the United States has remained stagnant at approximately 5,000 donors per year, while the waiting list for organs in 2004 exceeds 80,000 individuals. Each day in the United States 15 patients die while awaiting life-saving transplants. The method of allocation of these precious gifts is of importance to all patients, but is of particular importance to minorities. Although minorities are represented in all end-stage organ diseases, end-stage renal disease has by far the greatest impact on minorities. Diseases such as hypertension and diabetes, which can lead to end-stage renal disease and the need for transplantation, disproportionately affect minorities. Several key questions should be openly discussed and debated in regard to transplantation policy and minorities. Some of these questions might be: Is there proportionate representation of minorities on organ waiting lists? Does race impact organ availability? What are the reasons that waiting time is longer for minorities awaiting kidney trans-plantation? How can we increase organ availability for minorities? What should be the guiding principles of organ rationing? For many highly specialized procedures in the United States, racial differences in access to effective medical procedures persist. Minorities are far less represented than their majority counterparts, even when adjustments are made for economic status and education. Coronary artery bypass surgery, total knee and hip replacement, cataract surgery, screening colonoscopy and mammography are examples of such procedures where disparities exist. Access remains a critical issue. Two significant risk factors for renal disease, hypertension and diabetes, disproportionately affect African Americans. It is estimated that more 30% of adult African Americans are hypertensive, compared to a 20% incidence in the majority population. More importantly the age of onset in African Americans is earlier, resulting in higher age-adjusted hyperten-sion prevalence. This early onset subsequently leads to more target organ damage and greater overall mortality burden when compared with the majority white population. Although the difference is not as drastic with the incidence of diabetes, the risk of end-stage renal disease in African Americans with diabetes is three times as great as that of the majority population. Due to the greater burden of disease, the incidence of end-stage renal disease is much higher in African Americans. …