The authors discuss racial differences among organ transplant donors. They note that African Americans are much less likely than whites to be organ donors. This difference has resulted in highly consequential waiting lists for African Americans who require kidney transplants, but has not resulted in the same waiting lists for those requiring liver or heart transplants. The reasons are not clear, but the authors suggested two factors: (1) only kidney transplant requires HLA matching and (2) African Americans may be over-represented among patients with diseases that require kidney transplants but not among patients with diseases that require other types of organ transplants.

The authors suggested three possible reasons why African Americans donate less: they have less trust in the medical system, their religious beliefs preclude donation, and they have less awareness of the need for donation and/or mechanisms by which one donates.

Although the authors noted there have been positive developments in the trend toward increased organ donation among African Americans in recent years, they made three suggestions for further improvement.

1. Encourage African Americans to talk to their families about their wish to be an organ donor. African Americans are less likely than whites to donate organ for family members, particularly if there is uncertainty about the family members’ wishes. Additionally, African Americans are less likely than whites to discuss this issue with family members.

2. Health care providers should examine their own behaviors for those that potentially discourage African Americans from donating.

3. Distrust is likely to be due to institutionalized racism rather than directed at the organ donor system or transplantation specifically. Thus, any campaign to increase donation must address issues of trust and equity.