Requests for organ donors must be tempered by a better understanding of cultural differences

"We're seeing different cultural perceptions of life and death and that affects end-of-life decisions," says Kerry Bowman, a U of T professor with the Joint Centre for Bioethics and the clinical ethicist at Mount Sinai Hospital. Health care workers need to be aware that not all cultures consider organ donation justifiable, he says. His article, Cultural considerations for Canadians in the diagnosis of brain death," appears in the March issue of the Canadian Journal of Anesthesia.

In Canada, most organ donations come from people who have died, rather than from living donors. In western culture, there is a division between mind and body, he explains. Once the brain no longer functions, the corpse is no longer considered a true person -- as highlighted by Descartes' philosophy, "I think, therefore, I am" -- so organ donation is seen as acceptable. In addition, western society has been greatly influenced by the Christian belief in the spiritual value of non-reciprocal giving, says Bowman, making organ donation a gift of love and generosity.

By contrast, many non-western cultures perceive the boundary between life and death differently. From a traditional Japanese perspective, for instance, a person is often seen as the integration of mind, body and spirit. Even after death, that person remains an integrated whole, making organ donation disturbing to many Japanese.

Bowman wants health-care workers, especially those working on transplant teams and in intensive care units, to be more aware of these cultural differences and to respect them. "Education will not change cultural differences," Bowman says. "You can't simply give a medical lecture and expect people to abandon their cultural beliefs.

Bowman says that just because the Canadian health care system now has many workers of differing ethnicities, we should not assume cultural sensitivity is pervasive.

"We are all most aware of our own cultures, so we all need cross-cultural training regardless of our backgrounds," he said. "In Canada, we talk a great deal about the need for cultural sensitivity, but we have been very slow to rise to the challenge."