Do physicians favour men when deciding who gets an organ transplant? Dr. Lynne Young, a professor of nursing at the University of Victoria, believes that might be so.
Young points to some startling numbers in making her case. Over the past decade, 61.5 per cent of organ transplants in sa国际传媒 went to men.
Dig a little deeper, and the imbalance persists. During the same period, men received 72 per cent of heart transplants, provincewide.
Nor is this gender tilt confined to sa国际传媒 More men than women receive transplants across sa国际传媒, throughout the U.S. and in Europe.
Young doesn鈥檛 insist that bias is present. But she asks a fair question: If discrimination isn鈥檛 to blame, what explains this pervasive disparity between the genders?
She might carry her query a stage further. At first glance, ethnic minorities also appear disadvantaged.
In sa国际传媒, East Asian and Indo-Asian patients are 30 per cent less likely to receive kidney transplants. Among children, aboriginal kids get 36 to 54 per cent fewer kidney transplants.
And numerous studies have found that white patients in the U.S. receive more transplants than black or Latino patients.
In short, if bias is involved, it is apparently widespread, crossing international boundaries and harming not only women but also racial minorities.
But is that what鈥檚 happening? Much of the available evidence suggests otherwise.
Kidneys make up two-thirds of all transplants, and unfortunately it鈥檚 much more difficult to find a suitable match than with other organs.
Biology plays a role. Women who have been pregnant generate antibodies that limit the field of suitable donors.
Race also comes into it. Successful kidney matches are far more likely to be found in people of the same ethnicity.
That wouldn鈥檛 matter if donor rates were constant. But many Asian families have religious or cultural beliefs incompatible with the idea of organ transplants. That limits the pool of usable kidneys for this ethnic group. Aboriginal patients face similar constraints, though perhaps due more to geographic isolation.
These factors alone explain much of the race and gender disparity.
But size also plays a role. Men generally, and tall men in particular, have larger hearts and lungs than women. That reduces the supply of usable hearts for women.
Lifestyle must be considered. Women generally take better care of themselves (one reason they live longer). As a result, they either don鈥檛 contract diseases that require transplants, or they do so later in life when the operation might be more dangerous.
Finally, mindset is involved. For some reason, men as a whole are more willing to choose transplant surgery when the procedure is high-risk.
An American report found that if women who had refused a heart transplant were excluded from the study, the gender disparity vanished.
None of these factors, singly or combined, prove that bias is imaginary. Though they make that explanation less probable.
But they do illuminate the underlying realities that constrain this vital field of medicine. The question is, what can be done to improve access for under-represented groups?
The best way to improve the odds of finding a kidney match is to develop a national organ registry. Ottawa and the provinces have been working at this for years, though progress is painfully slow.
But a better outreach program is also needed within minority communities, to publicize the benefits of organ donation. Most potential donors don鈥檛 realize how ethnicity restricts the pool of suitable tissues. More would surely come forward if the facts were better known.
As the New Year opens, then, here is a resolution we can all make: Contact the sa国际传媒 Transplant Society at transplant.bc.ca, and give the gift of life.
