By Jenny Kang and Katarina Zorcic
91% of organ donors in Canada are Caucasian, even though this demographic only consists of 81% of the population (Li et al., 2015). Canada is home to a diverse population, with 22.3% belonging to a minority group. Of this subpopulation, most people belong to the East Asian, South Asian, or African, Caribbean, and Black groups (Immigration and Ethnocultural Diversity: Key Results from the 2016 Census, 2017). By examining factors contributing to this disparity in donation rates, appropriate educational resources can be created to help alleviate the shortage of donors. This article will focus on these three populations, examining discrepancies in organ donation and potential causes regarding culture and beliefs.
East Asian
Canada has a large and diverse population of East Asians, although a large portion of this group is of Chinese ethnicity (Government of Canada, 2017), consisting of people from China, Hong Kong, or Taiwan. Thus, most research has been conducted on the barriers that this ethnic group faces. The Chinese Canadian population has a disproportionately lower rate of organ donation compared to the general public and numerous factors contribute to this discrepancy. In Ontario, the most largely populated province, only 8.9% of Chinese Canadians are registered deceased donors, compared to 25.4% of the general public, making members belonging to this ethnic group almost three times less likely to be donors (Li et al., 2015). In numerous studies, most Chinese participants have agreed that organ donation is a good and noble act (Molzahn et al., 2005a), so then why are there not more registered donors? Various cultural beliefs likely play a role in affecting the attitudes and willingness for Chinese people to become donors. One impactful idea is filial piety, the Confucian belief that one’s body belongs to their ancestors and maintaining a whole body is a sign of respect (Perspectives on Organ and Tissue Donation among Chinese Canadians. – Free Online Library, n.d.). Similarly, many Chinese people are of Buddhist faith and in a study conducted by Molzahn et al. (2015), several Chinese respondents mention that it is preferred to maintain an intact body for reincarnation. These beliefs may prevent Chinese people from wanting to become donors since after donating one’s organs, the body is no longer considered intact. As well, the topic of death is a very sensitive subject for many Chinese people and given the importance of involving family in the decision-making process, having a conversation regarding organ donation decisions is a challenge which many Chinese families face (Molzahn et al., 2005a). However, if a prospective donor is able to have that difficult discussion about organ donation with their family, then the donor’s wishes would likely be respected after they pass.
South Asian
The South Asian community of Canada also exhibits a lower rate of organ donation than the general public, impacting their access to organ transplantation. The previously mentioned study by Li et al. (2015) also found that 12.8% of the South Asian population of Ontario are registered deceased organ donors, making them twice as likely to not be donors compared to the remainder of the population. Similar to the East Asian population, death is not a common topic of discussion and considering the value of family when it comes to decisions, many South Asians may not talk or think about organ donation. Numerous participants of one study mentioned the concept of destiny and thus, some members of this ethnic group may reject the idea of organ donation and transplantation as it does not align with their beliefs (Molzahn et al., 2005b). Furthermore, various spiritual groups have different rituals surrounding death, such as the desire to be cremated whole, which must be respected, particularly when discussing deceased donation (El-Dassouki et al., 2021). Moreover, evidence shows that Sikh and Hindu values surrounding altruism support organ donation while the ambiguity of Islamic views on organ donation may result in some hesitancy. However, whether religious beliefs impact willingness to donate is still unclear as some studies find it does not have a major influence on one’s attitudes toward donation.
African/Caribbean/Black
Though there has been limited research conducted on African, Caribbean, and Black Canadians, there is some evidence showing that they are less likely to be living kidney donors compared to white candidates. The importance of spiritual beliefs may influence the lower donation rates in this community as well. In one study, some Haitian Canadian participants expressed the desire to pass with their whole body while others were willing to donate as long as it did not interfere with their ability to go to heaven (Sherry et al., 2013). Additionally, mistrust in the healthcare system has been noted as a likely barrier to organ donation. Participants of one study had expressed concerns that physicians would be less likely to save the life of an organ donor. Others had also talked about their lived experiences of being “taken advantage of” by the health care system (El-Dassouki et al., 2021). Though additional research is required to assess the relationship between mistrust and organ donation, members of this community generally lack trust in the healthcare system as a result of institutionalized racism and generational trauma (We Need Culturally Appropriate Health Care for Black Canadians | CBC News, n.d.). Better understanding how the historic and personal experiences of this marginalized group impacts their attitudes toward organ donation is essential to increasing access.
Conclusion
Along with the rest of the world, Canada has been struggling with an ongoing shortage of organ donors, which has been called a crisis (Abouna, 2008). Various minority groups in Canada have clearly demonstrated lower rates of organ donation compared to the general public with unique influences including spiritual beliefs surrounding death, the nature of the topic of death itself, and mistrust in the healthcare system. It is crucial to address these issues in culturally sensitive interventions and support these communities to increase organ donation rates.
References
Abouna, G. M. (2008). Organ Shortage Crisis: Problems and Possible Solutions. Transplantation Proceedings, 40(1), 34–38. https://doi.org/10.1016/j.transproceed.2007.11.067
El-Dassouki, N., Wong, D., Toews, D. M., Gill, J., Edwards, B., Orchanian-Cheff, A., Neves, P., Marshall, L.-J., & Mucsi, I. (2021). Barriers to Accessing Kidney Transplantation Among Populations Marginalized by Race and Ethnicity in Canada: A Scoping Review Part 2—East Asian, South Asian, and African, Caribbean, and Black Canadians. Canadian Journal of Kidney Health and Disease, 8, 2054358121996834. https://doi.org/10.1177/2054358121996834
Government of Canada, S. C. (2017, October 25). Ethnic Origin (279), Single and Multiple Ethnic Origin Responses (3), Generation Status (4), Age (12) and Sex (3) for the Population in Private Households of Canada, Provinces and Territories, Census Metropolitan Areas and Census Agglomerations, 2016 Census—25% Sample Data. https://www12.statcan.gc.ca/census-recensement/2016/dp-pd/dt-td/Rp-eng.cfm?TABID=2&LANG=E&A=R&APATH=3&DETAIL=0&DIM=4&FL=A&FREE=0&GC=12&GL=-1&GID=1341682&GK=1&GRP=1&O=D&PID=110528&PRID=10&PTYPE=109445&S=0&SHOWALL=0&SUB=0&Temporal=2017&THEME=120&VID=28554&VNAMEE=&VNAMEF=&D1=0&D2=0&D3=0&D4=0&D5=0&D6=0
Immigration and ethnocultural diversity: Key results from the 2016 Census. (2017). 11, 8.
Li, A. H., McArthur, E., Maclean, J., Isenor, C., Prakash, V., Kim, S. J., Knoll, G., Shah, B., & Garg, A. X. (2015). Deceased Organ Donation Registration and Familial Consent among Chinese and South Asians in Ontario, Canada. PLOS ONE, 10(7), e0124321. https://doi.org/10.1371/journal.pone.0124321
Molzahn, A. E., Starzomski, R., McDonald, M., & O’Loughlin, C. (2005a). Chinese Canadian Beliefs Toward Organ Donation. Qualitative Health Research, 15(1), 82–98. https://doi.org/10.1177/1049732304270653
Molzahn, A. E., Starzomski, R., McDonald, M., & O’Loughlin, C. (2005b). Indo-Canadian Beliefs regarding Organ Donation. Progress in Transplantation, 15(3), 233–239. https://doi.org/10.1177/152692480501500306
Perspectives on organ and tissue donation among Chinese Canadians. – Free Online Library. (n.d.). Retrieved January 7, 2022, from https://www.thefreelibrary.com/Perspectives+on+organ+and+tissue+donation+among+Chinese+Canadians.-a0276137582
Sherry, W., Tremblay, B., & Laizner, A. (2013). An exploration of knowledge, attitudes and beliefs toward organ and tissue donation among the adult Haitian population living in the Greater Montreal area. Dynamics (Pembroke, Ont.), 24, 12–18.
We need culturally appropriate health care for Black Canadians | CBC News. (n.d.). Retrieved January 8, 2022, from https://www.cbc.ca/news/canada/british-columbia/black-canadians-health-care-1.5678614
Organ Advocacy Initiative 