Altruism, Privilege, and Coercion: How culture, race, gender, and social networks impact living organ donation

Virtual

Lead Speaker(s)

Shruti P. Mutalik, MD (she/her/hers)

Transplant and Consultation Liaison Psychiatrist, Mount Sinai Hospital
Icahn School of Medicine, Mount Sinai
New York, New York

Speaker(s)

Akhil Shenoy, MD

Associate Professor, Director of Transplant Psychiatry
Columbia University
New York, New York
Debra R. Kahn, MD

Professor, Consult liaison psychiatry Fellowship Director
UC Davis
SACRAMENTO CA, California
JB

John W. Barnhill, MD

Professor of Clinical Psychiatry, Professor of Medical Ethics
Weill Cornell Medicine
New York, New York

Abstract:

Background:

The national social justice reckoning following George Floyd’s murder in 2020 has resulted in a long overdue focus on disparities within medicine, to include transplant. Rates of living organ donation vary in groups separated by race/ ethnicity, sex/ gender and religious affiliation. The percentage of Black living donors is significantly less than that of White donors. Women account for higher numbers of organ donors than men. The reasons are multifactorial; however, medical racism, access to healthcare, socioeconomic disparities, cultural attitudes, religious beliefs account for some of the differences.

Increased rates of living donation through proactive efforts will benefit recipients. A diverse donor registry increases the chances of recipients finding a match. However, these efforts could selectively impact some groups more than others.

Eligibility to donate is contingent upon physical and mental health, social support, and access to health care services. As donation is a voluntary decision meant to be free of coercion, efforts to encourage donation cannot exist in a vacuum without addressing these inequities. Upholding autonomy and non-maleficence in living donors means reducing barriers to donation in those who would make good candidates, but also protecting vulnerable groups. Understanding disparities in living donation related to various aspects of identity can help donor teams develop a culturally informed formulation of donor decision making.

Format:

15 min: Dr. Mutalik will introduce the topic, provide an overview of disparities in organ donation, highlighting racial disparities and demonstrating how they are an epiphenomenon of systemic racism, resources for undocumented donors, religious attitudes, military and veteran donors

15 min: Dr. Shenoy will discuss the role of sex and gender in donor disparities, and highlight both national and international experiences

15 min: Dr. Kahn will discuss how the arborization of recipient social networks relates to donation. Social media sites such as Facebook allow individuals in need of a transplant to solicit donors in a non-confrontational manner, but also have limitations in their reach across socio-cultural divides. Donors and recipients without access to social media will suffer in their ability to reach others outside of their networks.

15 min: Dr Barnhill will discuss what transplant psychiatrists should know about organizations such as Renewal and the Effective Altruism movement and how these efforts can impact inequities in donation

15 mins: Q and A

Conclusions: Our goals will be to foster an equity informed understanding of donor decision making. We propose a framework for what mental health professionals can do to address disparities in donation and what advocacy means in this context.
This session is sponsored by Transplant SIG.
Learning Objectives:
To describe factors contributing to racial/ ethnic and sex/gender inequities in organ donation
To discuss attitudes to living donation in different religious groups and how this can inform our understanding of donor decision making
To discuss the role of proactive efforts to encourage living kidney donation in different groups of potential donors at the community level