Abstract
OBJECTIVE: To determine the relative admission rates of Asian and non-Asian patients to intensive therapy units (ITUs) in Coventry and to explore the implications of these rates for the transplantation of organs to Asian people. DESIGN: Examination of 1991 census data and a retrospective review of ITU admissions books. Data were collected on ethnic background, presenting diagnosis, and clinical outcome for each admission. SETTING: The three ITUs in Coventry. PATIENTS: All admissions to the ITUs from 1990-93 inclusive. RESULTS: Asian patients were admitted to ITUs disproportionately to their numbers in the Coventry population. Members of the Asian community were less than half as likely to be admitted to an ITU (p < 0.001) and more likely to die while there (p = 0.007) than members of the non-Asian population in Coventry. The proportions of patients referred to the transplant unit and the rates of subsequent donation do not seem to differ significantly for Asian and non-Asian patients (p = 0.26 in both cases). CONCLUSIONS: There are clear implications for the availability of cadaveric kidney transplantation to Asian patients, given that few kidneys from non-Asian donors are histocompatible with Asian recipients. Indeed, in Asians, promotion of living related donation may be more effective in countering the organ shortfall than efforts to increase consent to cadaveric transplantation. However, it may be valuable to investigate any patterns of morbidity or social or cultural factors that might explain the initial low admissions rates to ITUs for Asian patients.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Burden A. C., McNally P. G., Feehally J., Walls J. Increased incidence of end-stage renal failure secondary to diabetes mellitus in Asian ethnic groups in the United Kingdom. Diabet Med. 1992 Aug-Sep;9(7):641–645. doi: 10.1111/j.1464-5491.1992.tb01860.x. [DOI] [PubMed] [Google Scholar]
- Clark T. J., Richards N. T., Adu D., Michael J. Increased prevalence of dialysis-dependent renal failure in ethnic minorities in the west Midlands. Nephrol Dial Transplant. 1993;8(2):146–148. [PubMed] [Google Scholar]
- Gore S. M., Hinds C. J., Rutherford A. J. Organ donation from intensive care units in England. BMJ. 1989 Nov 11;299(6709):1193–1197. doi: 10.1136/bmj.299.6709.1193. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Higgins R. M., Edmunds M. E., Dukes D. C. End-stage renal failure in Indo-Asians. QJM. 1995 Jul;88(7):523–524. [PubMed] [Google Scholar]
- Kittur D. S., Hogan M. M., Thukral V. K., McGaw L. J., Alexander J. W. Incentives for organ donation? The United Network for Organ Sharing Ad Hoc Donations Committee. Lancet. 1991 Dec 7;338(8780):1441–1443. doi: 10.1016/0140-6736(91)92735-k. [DOI] [PubMed] [Google Scholar]
- Mather H. M., Keen H. The Southall Diabetes Survey: prevalence of known diabetes in Asians and Europeans. Br Med J (Clin Res Ed) 1985 Oct 19;291(6502):1081–1084. doi: 10.1136/bmj.291.6502.1081. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pazianas M., Eastwood J. B., MacRae K. D., Phillips M. E. Racial origin and primary renal diagnosis in 771 patients with end-stage renal disease. Nephrol Dial Transplant. 1991;6(12):931–935. doi: 10.1093/ndt/6.12.931. [DOI] [PubMed] [Google Scholar]
- Roderick P. J., Jones I., Raleigh V. S., McGeown M., Mallick N. Population need for renal replacement therapy in Thames regions: ethnic dimension. BMJ. 1994 Oct 29;309(6962):1111–1114. doi: 10.1136/bmj.309.6962.1111. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Simmons D., Williams D. R., Powell M. J. Prevalence of diabetes in a predominantly Asian community: preliminary findings of the Coventry diabetes study. BMJ. 1989 Jan 7;298(6665):18–21. doi: 10.1136/bmj.298.6665.18. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Teo Bernard. Is the adoption of more efficient strategies of organ procurement the answer to persistent organ shortage in transplantation? Bioethics. 1992 Apr;6(2):113–129. doi: 10.1111/j.1467-8519.1992.tb00190.x. [DOI] [PubMed] [Google Scholar]
- Wing A. J., Chang R. W. Non-heart beating donors as a source of kidneys. BMJ. 1994 Feb 26;308(6928):549–550. doi: 10.1136/bmj.308.6928.549. [DOI] [PMC free article] [PubMed] [Google Scholar]