Lost in Translation

Abstract

After several months of anthropological fieldwork studying living kidney donation (LKD) decisions, I was surprised how rarely patients of non-Western background appeared to have a relative willing to donate a kidney. If this indeed is the case, what are the reasons behind this imbalance? A patient with a familial kidney donor usually undergoes transplantation surgery within a few months. Waiting for a deceased-donor (DD) kidney takes a longer time. The tissue match is often inferior compared to when the donor is a close relative, resulting in shorter graft survival. Based on findings in my fieldwork, it would seem that culturally based obstacles trump medical common sense when non-Western patients decide against LKD. For the discussion that follows, I have selected 2 cases from my sample of 18 LKD cases from fieldwork (2008–2011) conducted at four hospitals in the greater Oslo area in Norway: one, a 45-year-old woman from Pakistan (the largest nonWestern minority group in Norway); the other, a patient originating from an African country. The former had several hypothetical donors, whom the nephrologist discounted for a variety of sociomedical reasons. The latter had four close blood relatives living in Norway, none of whom responded, despite the nephrologist’s repeated letters to discuss the possibility of LKD. Both patients ended up receiving a DD kidney. The cases may be critiqued for being too particularistic to provide general knowledge about why LKD is rare among families with Asian or African backgrounds. However, some of the reasoning I encountered has the potential to alert healthcare teams about unforeseen cognitive and emotional obstacles and misunderstandings. Several of these constraints may turn out to be modifiable, but only if they are taken seriously and addressed, not simply dismissed as communicative ‘‘noise’’ caused by superstition, ignorance, and misinformed cultural preunderstandings. First, a few words are in order about the Pakistani community and their relatively greater need for renal replacement therapy (RRT) compared to ethnic Norwegians. The prevalence of type 2 diabetes (T2D) among Pakistani women aged 30–67 is 14 times higher than among ethnic Norwegian women. Reports from the UK indicate that East Asian T2D patients develop end-stage renal disease three to four