Thank you for the opportunity to comment on “”Request for Information: Health and Safety Requirements for Transplant Programs, Organ Procurement Organizations, and End-Stage Renal Disease Facilities”. I am Jerrald Callanta, founder, and current CEO of Just Societies, a nonprofit organization that seeks to address and solve social issues by working alongside other community organizations to achieve feasible solutions. I would like to provide an answer to the question, “How can those in the transplant ecosystem better educate and connect with these communities about organ donation, so as to address the role that institutional mistrust plays in consenting to organ donation?”
As the policy has stated, and results have shown, there is a disproportionate amount of White transplant patients and candidates over Black patients and candidates. While White candidates make up about 40% of all candidates, they make up more than half of the transplants performed in 2020. In comparison, Black patients make up almost 29% of all candidates, however, only 22% receive a transplant. This could be due to implicit biases within the medical field, the circumstances due to race such as social or economic factors, or even patient mistrust of their medical professional(s).
To address the question, I shall focus on institutional mistrust, and a possible solution that can promote trust for the patient-medical professional relationship. African-American patients are more likely to mistrust their medical professionals comapred to White patients . Medical mistrust can unfavorably work against both the physician and patient’s self-interests, thus creating an outcome that is detrimental to both sides (Cuevas, O’Brien, & Saha). As a result, I propose a solution centered on the importance of cultural competancy.
Health-care ethicist, Martin Leever claims there are five components of cultural competancy: cultural awareness, cultural knowledge, cultural skill, cultural encounters, and cultural desires. Awareness centers on the possible biases medical practioners may have regarding an individual’s culture. Knowledge is knowing the norms of diverse cultures, skill is the ability to gather and identify culturally releveant facts in the assessment and treatment of patients. Cultural encounters and the desire to have these encounters are also important in practicing cultural competency (Leever, 562). Having these concepts could potentially address and solve the mistrust have many Black Americans have in the medical system.
Cultural competancy can be used to as a means to help mediate the disproportionate mistrust many Black Americans have in the medical system. Cultural awareness can be used as a means to address potential implicit biases medical professionals have towards different racial groups, and work towards not acting towards those biases. By focusing on cultural knowledge, medical professionals can further understand the root of mistrust towards the medical field that many Black and other POC patients have. Including how systemic oppression can play role in how one interacts and perceives the world. Cultural skill can also be used to identify what culturally relevant facts there are in providing treatment. For some cultures, there may be views that require different approaches, and having these facts acknowledged and respected, allows for patients to become more trusting of their medical professionals if they are willing to respect their cultures rather than override it.In regards to cultural encounters and desires, medical professionals have to want to be able to be have these encounters and be able to not only treat, but respect their patient’s culture as well. By respecting one’s culture it allows for a patient to grow more trust in their medical provider and become open to more treatment options, especially in instances that require a transplant.
In summary, I believe an approach centered on cultural competancy can be used to not only address the racial disparity of medical mistrust, but to also provide a solution that respects their culture, and allows their concerns to be heard and acknowledged by their medical professionals.
Founder and CEO, Just Societies