Effect of Race Upon Organ Donation and Recipient Survival in Liver Transplantation, Nov 1990:

Abstract

The effect of the race of the donor on organ donation and on the outcome of clinical liver transplantation has not been addressed previously. The aims of this study were to determine: (1) the number of organs donated by each of the major racial groups of the United States, (2) the outcome of transplantation of these organs across racial groups, and (3) the pattern of liver disease that required transplantation in each of these racial groups. A significantly higher proportion of organs were donated by white non-Hispanic Americans than either black or Hispanic Americans. There was no significant difference in survival when an organ was transplanted between black and white Americans and vice versa.

Currently, donors for liver transplantation are matched with recipients only according to ABO blood group compatibility and body size. Nonetheless, it is well known that man as a biological species is polymorphic, with significant variation occurring within the species. Despite genetic differences in the prevalence of blood groups and HLA antigens between the various races, the effect of the race of the donor and the race of the recipient on the outcome of clinical OLTx has never been investigated.

A retrospective analysis of all adult patients undergoing their first OLTx at the Presbyterian University Hospital of the University of Pittsburgh between January 1, 1981, and December 31, 1988

The race of the donor was determined by what the family members considered was their racial grouping, while that of the recipient was determined by what the patients considered their racial group to be. For the purpose of this study, a transplant failure was defined as a graft failure leading to retransplantation and/or the patients death within 60 days of the initial liver transplant.

The total number of livers donated by blacks (69) was far less than that by whites 795 (Hispanic and non-Hispanic). Of the 51 black recipients, only 5 (10%) received an organ donated by a black, while 46 (90%) received an organ donated by a white; conversely of the 813 white recipients, 749 (92%) received an organ from a white donor while 64 (8%) received an organ from a black donor (P < 0.001). The total number of organs donated by blacks for either black or white recipients was far less than that observed for whites and is well below their population fraction.

A breakdown of the white population into Hispanic and non-Hispanic groups (Table 3) shows that the number of organs donated by the Hispanic group is even smaller than that donated by the black population. Thus, most donors are white non-Hispanics and both Hispanic and black recipients are most likely to receive an organ donated by a white who is non-Hispanic.

PubMed Central, Table 1: Dig Dis Sci. 1990 November; 35(11): 1391–1396.

This table indicates the failure rate of black recipients of White livers is twice the rate for Whites recipients of any liver.

PubMed Central, Table 2: Dig Dis Sci. 1990 November; 35(11): 1391–1396.

This table excludes “hispanics”. A more honest term would be mestizo, meaning “people with a various degrees of Caucasian, Amerindian and African admixture”. The black recipient failure rate is still roughly twice the White failure rate. The article says:

The failure rate for an organ transplanted from a black donor into a white recipient was 14.1% (14.8% in the case of a white non-Hispanic) while the failure rate for an organ obtained from a white donor and transplanted into a black was 28% (30% for white non-Hispanics). These differences were not significant.

PubMed Central, Table 3: Dig Dis Sci. 1990 November; 35(11): 1391–1396.

This table directly contrasts White with “hispanic”. Note that it indicates the White failure rate is more than doubled when the donor is “hispanic”.

PubMed Central, Table 5: Dig Dis Sci. 1990 November; 35(11): 1391–1396.

This table indicates that the mixed race cases consistently result in higher failure rates.

Because of the small numbers involved, there was no statistically significant difference in the failure rate for recipients with either PBC, PSC, or AHF among the various races. Among recipients transplanted for PNC, no differences in the failure rate was evident when the donor and recipient pairs were either matched or mismatched for race.

When race was considered in addition to other variables such as age, sex, and ABO blood groups, no difference in outcome was found, although the number of blacks within each of these subsets was small.

DISCUSSION

No data exist with respect to the outcome of organ donation between racial groups in clinical liver transplantation. This is related in part to the difficulty in classifying individuals in one or another racial group based solely upon their physical characteristics—commonly referred to as the “typological approach.” Our definition was determined by what the patient or the donor’s family members considered themselves to be.

The main difficulty with the “typological approach”, or for that matter most any empirical approach to race, is that it runs afoul the anti-“racist” dogma that race doesn’t exist or doesn’t matter or is a social construct of oppressive Whites. Race is not supposed to be real or important or objective despite all the indications that it is. The fact that any deliberate measure of the actual effects of such obvious biological differences could be put off for so long, despite the potential (and apparently substantial) life-threatening impact, is a good indication how all-important anti-“racist” ideology has become.

The present study confirms the low rate of donation of livers among blacks and Hispanics. It also shows that transplantation across racial groups has no effect upon the transplant outcome. The importance of determining the severity of the recipient’s illness and correcting for such is also illustrated in this study. The apparent higher failure rate for organs obtained from white donors and transplanted into black recipients was due entirely to the fact that a higher proportion of the black recipients who died were more seriously ill (4–6 on UNOS scale) than were the white recipients who were transplanted in this series (Table 4). However, a difference in survival rate for transplants performed between white Hispanics and white non-Hispanics also was noted. The numbers within this group are small, however, and thus no definitive conclusion can be drawn from the data.

The genetic differences owing to race per se are not considered to be major, as the genetic variability within each race is greater than the variability between the races. Moreover, it has been variously estimated that black Americans have a 30–50% chance of having a white ancestor (10). Because of this fact and because of the findings in this study, the likelihood of graft failure solely as a result of the presence of a genetic difference between the race of the donor and recipient is not tenable. This conclusion is consistent with studies recently reported for renal transplantation from our center (11). Thus transplantation of organs across racial groups can be performed without fear of an additional problem occurring as a result of some inherent difference between the donor and recipient races. Our data indicate that the major problem in success of liver transplantation is the severity of the illness of the recipient immediately prior to the transplant.

The numbers in the tables contradict the textual denials which accompany them. The reasons provided – statistical insignificance, severity of illness – are not accompanied by any detailed exposition. The raw numbers indicate a consistently higher failure rate for cross-race transplants, and at the very least suggest that more deliberate research is warranted.

They claim similar results for kidney transplants. Similarly flawed perhaps. The problem with cross-race kidney transplants is described in the following reports.

Donor Race May Impact Kidney Transplant Survival, Oct 2009:

“We found that transplant between races had better outcomes than transplant across races,” says Anita Patel, M.D., transplant nephrologist at Henry Ford Hospital Transplant Institute and lead author of the study.

By regression analysis, the non-black recipients who received a kidney from black donors had a significant lower survival rate compared to those who received a kidney from a non-black donor (hazard ratio 1.111, p=0.014) after adjusting for all known variables.

“Hepatitis C infection in the donor or recipient was seen as a significant risk factor for mortality,” says Dr. Patel.

Dr. Patel presented a similar study earlier this year which looked at race and the effect on renal allograft survival in different donor/recipients pairs. In that study, Dr. Patel found an increased risk in graft failure in non-black recipients of non-heart beating black donor kidneys. They appeared to have a two-fold increased risk of graft failure.

Twelve percent of living donors are African-American.

Genes, not race, determine donor kidney survival; Implications for kidney transplant recipients and kidney donors, May 2011:

“It’s been long observed that kidneys taken from some black donors just don’t last as long as those taken from non-black donors, and the reason for that has not been known,” said Barry I. Freedman, M.D., John H. Felts III Professor and senior investigator. “This study reveals that the genetic profile of the donor has a marked affect on graft survival after transplantation. We now know that these organs aren’t failing because they came from black donors, but rather because they came from individuals with two copies of a specific recessive gene.”

Long observed, and long ignored.

The researchers identified that kidneys from donors who had specific coding changes in a gene called apolipoprotein L1 (APOL1) did not last as long after transplant as those from donors without these changes. These coding changes in the APOL1 gene that affect kidney transplant function are found in about 10 to 12 percent of black individuals. Recent studies, led by Freedman and his colleagues, have shown that these genetic changes are associated with an increased risk of kidney disease, which prompted researchers to investigate the role of these changes in transplant success.

“In looking at the records and follow-up of the recipients of these organs, we accounted for all the usual factors that are known to contribute to more rapid loss of kidney function after transplant,” said Freedman, chief of the section on nephrology. “What we found was that the kidney disease-causing risk variants in APOL1 were the strongest predictor of graft loss after transplant. The effect of having two copies of this gene was stronger than the impact of genetic matching between donor and recipient, the amount of time the organ was out of the body, and the antibody levels. APOL1 dwarfed all these other factors known to affect survival.”

A more honest title for this article would be, “Race denial causes death”, or “Genetic factors finally discovered despite race denial”.

There is no “black gene”. There are many black genes. This is one of them.

The problem is avoided entirely by avoiding cross-race transplants.

Citation: Sade RM. Transplantation, the Organ Gap, and Race. J So Carolina Med Assoc 1999; 95(3):112-115 (PDF):

Institute of Human Values in Health Care • Medical University of South Carolina

The issue of race poses special problems in transplantation. Because of the prevalence of hypertensive renal disease in the black population, that group has a disproportionately high representation on the kidney transplant waiting list. While blacks compose 12% of the general population, they comprise 37% of the kidney transplantation waiting list, yet receive 25% of the kidney transplants. Other organs are not so disproportionate.

A variety of factors contribute to differences among races: biological, medical, social, and personal. Biological factors include different rates of ABO blood groups within races, as well as differences in major histocompatibility complex antigens. Because of these differences, organs from black donors have a better match with potential black recipients than white. Blacks have a lower donation rate than whites, for reasons discussed in more detail below, contributing to fewer available biologically compatible organs for blacks than for whites.

Confirms racial differences reflected in disparate incidence of disease, distribution of blood types, donation rates.

Such a program is likely to disproportionately benefit the rate of transplantation in the black community. Blacks donate organs at a lower rate than whites. There are many reasons for this, but prominent among them are distrust within the black community of the health care system and of medical authority, and the belief that donated organs from blacks will go to other races. A system in which black persons could specify that their organs could go only to other blacks would give them a special reason to donate. An additional benefit of an increase in black donation rate is that blood groups and histocompatibility antigens have different distributions in different races. Therefore, as the black donation rate goes up, the number of transplants into blacks will increase, and longevity of the implanted organs will improve as well.

As with blood, an examination of organ transplants indicates that race not only exists but has significant consequences. When something is perceived to be somehow negative for non-Whites the “medical community” argues openly and unabashedly to help them, even if that means acknowleding race and racial differences. Meanwhile, concern for White lives is pathologized and demonized. This dishonest regime is called anti-“racism”. Anti-“racism” causes White deaths.

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In the spirit of the topic of this installment, race-related donations, I’d like to echo the appeal and rationale expressed by Carolyn Yeager at the beginning of Upholding Standards Within the Truth Community, broadcast on 18 March 2013. Please show your support for our work by contributing money, recommending tWn to friends and family, linking tWn at forums you frequent, and also by making helpful, intelligent comments here on our site.

The main topic of this installment are the racial disparities in organ disease and donor rates, including in the pro-non-White spirit reflected in the attitudes with which these disparities are commonly discussed.

Organ and Tissue Donation 101 – The Office of Minority Health

Why is it Important for Minorities to Donate?

The need for transplants is unusually high among some ethnic minorities. Some diseases of the kidney, heart, lung, pancreas, and liver that can lead to organ failure are found more frequently in ethnic minority populations than in the general population. For example, Native Americans are four times more likely than Whites to suffer from diabetes. African Americans, Asian and Pacific Islanders, and Hispanics are three times more likely than Whites to suffer from kidney disease. Many African Americans have high blood pressure (hypertension) which can lead to kidney failure. Some of these diseases are best treated through transplantation; others can only be treated through transplantation.

The rate of organ donation in minority communities does not keep pace with the number needing transplants. Although minorities donate in proportion to their share of the population, their need for transplants is much greater. African Americans, for example, are about 13 percent of the population, about 12 percent of donors, and about 23 percent of the kidney waiting list.

Successful transplantation is often enhanced by matching of organs between members of the same racial and ethnic group. Generally, people are genetically more similar to people of their own ethnicity or race than to people of other races. Therefore, matches are more likely and more timely when donors and potential recipients are members of the same ethnic background.

Here, with the imprimatur of the US government, is a clear enough statement that race exists and is in fact critically important. It is acceptable to discriminate on the basis of race when the purpose is to better serve anyone but Whites.

Attitudes and beliefs about organ donation among different racial groups.

Abstract

Many people on the waiting list for organ donation die each year without receiving organs. The shortage of organs is even more pronounced in minority communities. Despite the fact that minorities are at higher risk, they may be less likely to support or consent to organ donation. This investigation was undertaken to study racial factors in organ donation, by focusing on differences in awareness, attitudes, and behavior.

From the PDF:

The shortage of organs is even more pronounced in minority communities. For example, due to their increased incidence of hypertension with end-stage renal disease, a disproportionately large number of African Americans await kidney transplants. Despite this greater risk, African Americans are less likely than other racial groups to support or consent to organ donation (Gallup, 1993, unpublished data).25 An additional concern is that African-American recipients face a decreased likelihood of successful transplantation due to poor tissue match if the donor is not also African American.6 Although Hispanic Americans have not been shown to represent a larg- er than expected portion of patients on organ recipient lists, it has been documented that they are less likely than whites, but more likely than African Americans, to express their support of organ donation in surveys and to consent to organ donation (Gallup, 1993, unpublished data).5’7

Several studies have investigated why minorities are less likely than whites to support organ donation. Some of this is attributable to differences in access, ie, minorities are less likely than whites to have access to adequate medical care and to information about organ donation.2’5’7 In addition, the relatively low confidence in organ donation that has been found among African Americans has been attributed to differences in religious beliefs and a distrust of the medical community as a whole.6’8 Among Hispanics, differences in language and the role of the family in decision making are reported to be barriers to organ donation.7’9 It also has been reported that a person’s level of education, which often is associated with minority status, is directly correlated with his or her support of organ donation and the likelihood of signing an organ donation card (Gallup, 1993, unpublished data).

Here and in subsequent examples many reasons are considered to explain and excuse non-White failure to donate. Most often it includes the fact that non-Whites simply don’t trust “the medical community”. Note the one explanation that isn’t considered is “racism”, even though that is always the first and foremost explanation when some perceived “failure” on the part of Whites is discussed.

Organ donation and culture: a comparison of Asian American and European American beliefs, attitudes, and behaviors. [J Appl Soc Psychol. 2000] – PubMed – NCBI:

Abstract

The well-known gap between organ-donor supply and demand in the United States is particularly acute for Asian Americans. Lower participation in organ donation programs by Asian Americans has been hypothesized as one explanation for this observation. This study finds that, relative to European Americans, Asian Americans hold more negative attitudes toward and participate less frequently in a large, urban organ-donor program.

Once again, they have “more negative attitudes” and “participate less frequently”, but it’s perfectly understandable, even if the actual reasons aren’t yet understood.

The need for increasing organ donation among African Americans and Hispanic Americans: an overview. [J Emerg Nurs. 1999] – PubMed – NCBI:

We know that most Asian countries, such as Japan, have only recently begun organ donation programs. The United States represents one of the most culturally heterogeneous populations in the world today. Health care workers are called on every day of their lives to overcome cultural or ethnic differences, and at no point during the health care process is culturally competent care more necessary than during the final hours of a person’s life. Organ donation is a question that should be asked of every family that loses a loved one so that they can have the opportunity to give of themselves in an effort to save the lives of others.

Overcoming differences, culturally competent care – these are just a few of the costs of the multicult. The burdens imposed by heterogeneity make it less likely that anyone will “give of themselves” to “save the lives of others” – behavior which comes naturally in the homogeneous White societies that the multicult destroys.

Racial disparities in organ donation and why. [Curr Opin Organ Transplant. 2011] – PubMed – NCBI:

Abstract

PURPOSE OF REVIEW:

High prevalence of comorbidities such as diabetes, hypertension, obesity, hepatitis B and C, in minority groups, results in racial minorities being disproportionally represented on transplant waiting lists. Organ transplantation positively impacts patient survival but greater access is limited by a severe donor shortage.

RECENT FINDINGS:

Unfortunately, minority groups also suffer from disparities in deceased and living donation. African-Americans comprise 12.9% of the population and 34% of the kidney transplant waiting list but only 13.8% of deceased donors. Barriers to minority deceased donation include: decreased awareness of transplantation, religious or cultural distrust of the medical community, fear of medical abandonment and fear of racism. Furthermore, African-Americans comprise only 11.8% of living donors.

This article speaks fairly directly about racial differences in disease and donorship. But the length of the waiting list is not only because of the race-based disparity between supply and demand rates. What is known but left unsaid here is that the wait, especially for kidneys, is also because race-based organ compatibility is important.

Race matters more than most of these articles are willing to admit, at least all at once. Each ignores or plays down or even flatly denies one or more aspects of race, which are revealed by consulting other sources which conceal a different mix of the facts.

SUMMARY:

Transplant center-based education classes significantly and positively impact African-American concerns and beliefs surrounding living donation. Community and national strategies utilizing culturally sensitive communication and interventions can ameliorate disparities and improve access to transplantation.

Stripping of its “culturally sensitive” trappings, this is an open call for more government-backed efforts to urge blacks to do what’s best for blacks.

Bone Marrow Transplants: When Race Is an Issue – TIME, Jun 2010:

Devan would need a marrow transplant. The prospect of going through chemotherapy for a second time and needing a transplant is daunting to anyone, but it’s especially harrowing if — like Devan — you’re of mixed race. Multiracial patients often have an incredibly hard time finding life-saving marrow matches. When Devan, whose father is Caucasian and mother is part Indian, was first diagnosed with leukemia, his family did a search of the international marrow registry that contains over 14 million donors and came up empty. “We knew there was nothing out there for him,” Tatlow says.

Compared to organ transplants, bone marrow donations need to be even more genetically similar to their recipients. Though there are exceptions, the vast majority of successful matches take place between donors and patients of the same ethnic background. Since all the immune system’s cells come from bone marrow, a transplant essentially introduces a new immune system to a person. Without genetic similarity between the donor and the patient, the new white blood cells will attack the host body. In an organ transplant, the body can reject the organ, but with marrow, the new immune system can reject the whole body.

To find a marrow match for anyone is hard. Even within one’s own family, the chances of finding one are only about 30%. According to the World Donor Marrow Association, while two out of three Caucasians find a match, the chances of a patient from another ethnic background can be as low as one in four. Despite rapid improvements in marrow registries around the world, the global registry is still disproportionately represented by the U.S., U.K. and Germany — all predominantly Caucasian countries. For a multiracial person, the chances are usually even worse. Athena Mari Asklipiadis, the founder of the California-based Mixed Marrow, one of the only outreach groups devoted to recruiting mixed race donors, says “the numbers are quite staggering … People compare it to winning the lottery.”

It’s difficult to ascertain the exact chances of finding a match for a mixed race person because the different combinations have different success rates, and the U.S.-based National Marrow Donor Program (NMDP), which has about eight million donors in its registry, does not have statistics on the success rates of mixed race patients. But Asklipiadis maintains the rates are lower — much lower. “God forbid I need a match, because I’m a very rare combination,” Asklipiadis says of her mixed Japanese, Italian, Armenian, Egyptian and Greek background.

Recall how in the 1940s the Boasian/jewish/commie anthropologists behind The Races of Mankind said race and race mixing doesn’t matter, and “science” proved it? They were lying. Organ transplant incompatibility, most obvious in the case of bone marrow, is an undeniable, biological down-side of race mixing. The subject is only broached here to help mixed race people after the fact. It would be far better to inform people of this reality before they create mixed-race children.

Tatlow recently received another call, this one bearing good news. Devan’s doctor informed the family a cord blood match had turned up. It’s not a perfect solution, but Devan’s doctor says it’s good enough. Blood from the umbilical cord is rich in blood-forming cells, and cord blood doesn’t have to match quite as closely as marrow from an adult. In the U.S. registry, compared to the over eight million potential marrow donors, there are only about 160,000 cord blood units. Tatlow urged pregnant women to donate their cord blood: “For pregnant women, your baby’s umbilical cord, which is otherwise thrown away, can save a life. It just seems like a very simple thing to do for the greater good of mankind.”

Except, as with organ donations in general, it is not “for the greater good of mankind”. It’s for the greater good of race mixing and non-Whites, to the detriment of the greater good of the rest of mankind, i.e. Whites.

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