As a 55-year-old African American male in an institutional environment bombarded with daily instances of life and death decision-making, my own mortality became unavoidable. I was certainly not in denial that death is an unavoidable part of the life cycle, yet such cases and others not involving organ donation create an “in your face” scenario that caused me pause.
Popular singer Tori Kelly recites these words as the chorus of the song “Questions” from her 2018 “Hiding Place” gospel album: “What happens when the healing never comes? Do we stand and curse the heavens or lift our hands and feel the sun? The mystery’s not clear. Just once Your voice I’d love to hear. What happens when the healing never comes?” (fmchr.ch/tkquestions).
I recently completed my Clinical Pastoral Education (CPE) residency, and I have been privileged to provide support and minister to families who have been confronted with making the decision regarding the remains of a loved one. I have participated with the interdisciplinary team members during family meetings as well as with fellow chaplains providing support for family and staff as well. In serving, I have assisted in leading, planning, participating and performing services in recognition of the familial decision for organ donation.
Organ donor? This is a question that every person applying for a driver’s license will need to answer.
This all-important response on your application, a legal form or a donor registration card just may save one or more lives.
The number of cases I encountered involving organ donation with affirmative decisions, while not excessive, seemed alarmingly high in relation to the demographic category in which I am identified (40- to 60-year-old African American male). The statistics left me pondering, “Is institutional health care intentionally targeting African American patients for organ donations?”
The response to the initial portion of the question I am posing — “Is institutional health care intentionally targeting?” — is a resounding “yes,” and that is not a bad thing.
According to organdonor.gov, as of January 2019 more than 113,000 men, women and children are on the national transplant waiting list; 20 people die each day waiting for a transplant and every 10 minutes another person is added to the waiting list. This same report addresses that only three in 1,000 people die in a way that allows for organ donation. And accordingly, “each year, the number of people on the waiting list continues to be much larger than both the number of donors and transplants.”
Researchers Thomas Hugh Feeley and Shin-Il Moon acknowledge the clear disparity regarding the number of organ donations needed and donors. Because such disparity exists, the published announcement stands as a need for education and the means of addressing intentional methods to “decrease the gap between the organ donation need and supply.” Their article (fmchr.ch/organed) acknowledges, “Family consent rates tend to range between 54% and 62% nationally.” This article also states that approximately 40% of patient families decline consent for organ donation of their deceased loved one. We must consider how many more lives would be exponentially impacted by moving the needle of “consents” a few percentage points.
The National Survey of Organ Donation Attitudes and Behaviors noted in its executive summary that when documenting racial groups and their openness to considering donations, African Americans ranked the “least open” with 9.5% responding “definitely yes.” It will likely not be surprising that the people who have not granted permission for their own organ donation were “significantly more likely to be African American or Hispanic” (fmchr.ch/dhhssurvey).
The broad range of information available regarding organ donation leans into discovering ways of increasing donors and donations. Hosts of research address the factors regarding decision-making and influence, resistance, discouragement and the means by which the timing of the conversation relates to the potential benefits or harm of the families deciding on behalf of their loved ones.
In a Metro Atlanta-based study, conducted by Emory University, it pleased me to hear the confession and reality of the behavior whereby church members, in all their trust of church leadership, “may not want the church ‘prying’ into their health behaviors. … The clergy felt conflicted: they felt it their responsibility to move beyond religious and spiritual education to health education, but they had questions how to do so effectively” (fmchr.ch/ehclergy).
The response to the second portion of the question I am posing — “Is institutional health care intentionally targeting African American males” — may also be a resounding “yes.” And that is not a bad thing.
My initial concern was for the African American male patients whose families were — through my lens of racial observation — inequitably subjected to the request to be organ donors. What I discovered was not what I had thought. I discovered that the process of request was the same for all families needing to make the decision, and I had been present during a season when the patients’ families affirmed the donation.
I announced to my 2019 graduating class of CPE interns and residents that CPE may more accurately stand for “Cardio Pulmonary Examination.” It seems I needed my own “heart transplant” as my mind is drawn to Ezekiel 36:26, “And I will give you a new heart, and a new spirit I will put within you. And I will remove the heart of stone from your flesh and give you a heart of flesh” (ESV).
For a number of years, I have checked the box on my driver’s license application to be an organ donor, and now, as a chaplain and pastor, I feel a deeper responsibility. As I consider (after reviewing research) my advocacy for organ donation and recognize that there are persons who may be in categories of doubt and simply in need of additional education, my intent is to join those identifying potential donors, African American and more.
- Elliott Renfroe is a Free Methodist elder serving as the chaplain at Westminster Village in Bloomington, Illinois, and as a member of the Greenville University Board of Trustees and SEED Livelihood Network’s Advisory Team. He previously served as the president of the Free Methodist Urban Fellowship and as a pastor in the North Central Conference.