The complex factors regarding organ donation decisions—including trust and distrust in the healthcare system—seem particularly salient for minority populations and populations that experience disparities in the amount or quality of health care that they receive. Although minority populations have a pressing need for transplantable organs, especially kidneys, there is some evidence that minority families have not been asked to donate as frequently when the patient is eligible (see below). Other factors associated with low rates of donation include concerns about the equity of the organ distribution system and a lack of information about the need for donor organs. The current statistics regarding deceased donation show marked increases in minority consent, particularly among African-American and Hispanic populations. As indicated earlier in this chapter, recent data show that most minority populations are donating organs and tissues at rates that are in proportion to their percentage of the U.S. population. It is difficult to make generalizations about any particular minority group because of the broad differences in the cultural norms, belief systems, and traditions within each group.

Individual Decision Making

Past studies have found that minority populations signed donor cards at lower rates, expressed less willingness to donate, and had lower consent rates overall; but recent statistics indicate a trend toward increased rates of consent to deceased organ donation. A random-digit-dialing telephone survey of 453 individuals in three cities in the early 1990s found that African Americans were more likely than white Americans to believe that healthcare professionals will not do as much to save their lives if they are designated organ donors and to characterize the organ distribution system as unfair (Siminoff and Saunders Sturm, 2000). Similarly, a study by Boulware and colleagues (2002a) found that African-American men and women trusted the healthcare system less than a comparable white population. In that study, spirituality and religion were key factors in the individual’s decision regarding donation. An earlier study also found that beliefs about institutional racism were a factor in donation decisions (Ohnuki-Tierney et al., 1994). Creecy and Wright (1990) found that knowing someone of similar ethnicity who had received a transplant was associated with a willingness to donate.

Although Hispanics and Latinos now comprise a significant portion of the U.S. population, far less research has examined their attitudes toward organ donation and their donor behavior. In a study by Alvaro and colleagues (2005), in which 1,203 Hispanic American individuals participated

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