office (03) 9820 3006 or 920 3008
fax (03) 9820 3007

Organ donation

Cultural competence in organ donation and transplantation in multicultural Australia

Maurice Eisenbruch, Malgorzata Kurjanska (and acknowledgement of the participation by Jeffrey Cohen)

o   The education of communities takes place in a moral register, revealing the deep attitudes towards the target group held by the health sector generally and in particular the organ donor coordinators.
o   People from culturally and linguistically diverse backgrounds who are ‘minorizé’ – made to feel that they are marginalised ‘ethnic minorities’ – will  be unlikely to be energised to donate organs to the nation’s organ pool. Donation procurement therefore is a system issue, inseparable from national multicultural policy.
o   While a procurement strategy centred on the provision of translation of generic information to the languages of each ethnic group may be within the comfort zone of the health system, it will fail. The barriers are along the lines of social cohesion rather than specific language-defined cells. Donor coordinators carrying out educational activities with targeted ethnic communities will also need support and training to increase their cultural competence
o   Ethnicity and race are highly contested terms. Health workers in the donation transplantation field tend to think of ethnicity and race in terms of individuals. should think more in terms of institutional design and organisation. Evaluation of donor and transplantation programs that are based on variables such as country of birth or language spoken at home will cut across key social determinants of health, ignore the diversity in individual experience and the history and context of immigrant groups and their families, and lead to confounding variables, spurious data and meaningless conclusions.
o   Race and ethnicity are misleading categories which homogenise indigenous people  in Australia and as Cass has highlighted, may be Aboriginal or Torres Strait Islander in origin; live in a city, a small town or a remote community; have limited or ready access to specialised medical care; and may be diabetic or non-diabetic.
o   While it is essential to engage the spiritual and secular leadership of ethnic community groups, it would be inappropriate to pass responsibility onto their shoulders. A number of the newer and emerging communities do not have the capacity to take this responsibility and some of the more established immigrant groups (as reported for example among the Afro-Caribbeans in the United Kingdom) may have lost their social community. What is more, community development cannot take place in isolation from a process that transforms the cultural competence of the wider system.
o   Genetic patterns and tissue differences are seen by tissue types, but this category does not necessarily match with the socially constructed categories such as ‘ethnic group’ commonly used in organ procurement.
o Given that Australian immigration patterns are increasingly Asian and African, and that intermarriage is likely to continue to spread the gene pool across Australia, the allochthone to autochthone ratio might continue to increase. It is unlikely that this would significantly reduce the likelihood of finding an exact tissue match for the overall group of people on waiting lists in Australia. On the contrary, the increased diversity of the gene pool (hurried along by more relaxed criteria for an tissue match) might even shorten the waiting list times, might increase compliance with post-transplantation treatment and thereby improve the chances that the graft would succeed, and could improve social outcomes as quality of life is better with a transplant. The majority in Australia of European stock would not lose out. Unfortunately, it would seem that Indigenous Australians, being of a separate HLA type, are unlikely to benefit from this process and there is an equity argument that less stringent matching criteria should be applied in the interest of adding quality and perhaps years of life.
o   The best long term solution to the disparities in organ donation and transplantation is to eliminate the underlying health disparities and the inequities of access to health services affecting both migrants and indigenous people in Australia.  

Download Organ Donation and Transplantation - European Science Foundation Workshop, Birmingham, September 2004