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RE: Indo-Asian experience of renal transplantation in Yorkshire: results of a 10-year survey.

We read with interest the article by Jeffrey et al. (1), which surveyed over time access to, allocation of, and subsequent postkidney transplant survival among Asians in Bradford, United Kingdom. The findings suggested that whereas Asians had similar access to the waiting list as their white counterparts, they had a significantly reduced chance of being allocated an organ, and even when they did receive a transplant, their survival rate was inferior. The primary reason put forward for this state of affairs was difficulties with human leukocyte antigen matching arising from the apparent reluctance of the Asian community toward donation. They concluded that the reasons for lack of organ donation in the Asian community are likely to be “complex.” However, what they do not say is that the answers to these complex reasons are not purely in the domain of medicine and epidemiology, but are also likely to lie within the sociomedical and relational component of the community, namely, in the field of medical sociology. Therefore, because their study was largely based on medical epidemiology, they did not have scope for in-depth discussion. We (and others) have investigated this issue on the basis of education and religious and racial discrimination within Asian communities in the United Kingdom (2–4). Our own findings from a community-based educational transplant forum conducted among Asians in Glasgow, Scotland, suggested that the reasons for paucity of organ donation among Asians are indeed complex (4). Over 300 members of the Asian community attended the information forum, and 80 attendees completed the sociologic survey. Our findings suggested that there was almost no opposition to organ donation in the Asian community. Furthermore, they were aware that religious leaders in the United Kingdom had endorsed organ donation and were unhappy that Asians were suffering as a result of a lack of organs. In particular, there was a favorable response to live donation and little discrimination with regard to the gender, age, or social role relationship between donor and recipient. However, to our own dismay, their favorable disposition toward organ donation was not accompanied by the carrying of an organ donor card. Detailed analysis of the sociologic survey suggested that although Asians were in favor of organ donation, they were not emotionally connected to the issue. To facilitate an emotional connection, we suggested that the concept of organ donation, and more specifically, the emotional and medical distress associated with living with an enduring prognosis (chronic renal failure), needed to be integrated into the Asian culture through use of the arts, literature, media, and cuisine. The two groups that appeared to be best placed to do this appeared to be religious leaders who might be used as cultural “integrators” as opposed to their more traditional role of cultural “prescribers.” The second group is mothers over the age of 30 who, although they appeared to hold less social, economic, and political power in the community, were central to the “social networks” and in a position of centrality regarding communication (4). We suggest that to promote organ donation among the Asian or any other minority racial groups, sociologic investigation aimed at understanding the values, attitudes, and beliefs of that community needs to parallel any medical, epidemiologic, or educational initiatives.