COMPARED WITH dialysis therapy, it has been shown that kidney transplantation provides patients with end-stage renal disease (ESRD) improved physical and mental health, and is more cost-effective.1,2 However, rates of transplantation referrals are not consistent among ethnic groups of patients with ESRD. African Americans are much less likely than white patients with ESRD to be referred for a renal transplant, placed on a waiting list for a kidney, or receive a kidney transplant.3-5 Conclusions on these disproportionate levels of transplantation referrals have not included many theoretically substantiated causes or solutions. The US Department of Health and Human Services, commenting on this problem, reported: “This and other research does not allow us to identify with certainty the factors which prevent equitable access to organ transplantation.”6 Explanations for minority underutilization of transplantation as a treatment modality for ESRD have included socioeconomic, medical, and patient-preference factors. Because African Americans are less likely to have health insurance and generally have lower socioeconomic status than Caucasians,5,7 many have theorized that insurance and socioeconomic status are determining factors regarding the significant racial disparity among kidney transplantation referrals. However, there is no evidence that inadequate black insurance coverage is responsible for the grossly disproportionate rates of transplantation referrals because this significant disparity exists even after controlling for socioeconomic and insurance status.4,8 There may be medical factors explaining lower transplantation rates for black patients with ESRD because African Americans wait longer for a kidney transplant than white patients.6 However, an extensive literature search was unable to show evidence linking a longer wait time for a kidney transplant to less interest or evaluation for such among black patients with ESRD. Fewer organ donations among blacks may be caused by the third explanation offered to date regarding the incongruity of kidney transplantation referrals in black patients: patient preference and distrust of the medical community. Black patients have been found to be more likely than white patients to have religious objections or problems with the concept of cadaveric transplantation.5 However, a literature review failed to find evidence that religious objection is linked to a majority of black disinterest in transplantation and also failed to locate a religious doctrine against transplantation. When studying reasons for African Americans refusal of organ donation, religious myths and misperceptions, distrust of the medical community, and racism have been among the reasons for refusal.9,10 However, there is yet to be evidence linking this distrust to less interest in obtaining a kidney transplant.
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