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Journal of Public Health Advance Access originally published online on July 14, 2006
Journal of Public Health 2006 28(3):226-234; doi:10.1093/pubmed/fdl045
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© The Author 2006, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.

Attitudes to kidney donation and registering as a donor among ethnic groups in the UK



Myfanwy Morgan, Reader in Sociology of Health

Richard Hooper, Lecturer in Medical Statistics

Maya Mayblin, Research Associate

Roger Jones, Wolfson Professor of General Practice
Division of Health and Social Care Research, King’s College London, Capital House, Weston Street, London SE1 3QD, UK

Address correspondence to Dr Myfanwy Morgan, E-mail: myfanwy.morgan{at}kcl.ac.uk

Background Kidney organ donation rates continue to be low among ethnic minorities, leading to disproportionate numbers awaiting transplants, longer waiting times and problems of tissue matching.

Methods A questionnaire survey was undertaken based on a convenience sample of general practice attenders to examine knowledge and attitudes to organ donation among ethnic groups. Responses were analysed using logistic regression for seven ethnic groups, controlling for age, gender and education.

Results About 1606 (84.4%) of people approached agreed to participate, and 1536 (95.7%) questionnaires were fully completed. High proportions of all ethnic groups were aware of the possibility of leaving kidneys for transplant, and ethnic minorities were significantly more aware of the urgent need for donors. However, negative attitudes to organ donation involved multiple issues rather than a single barrier, including worries that their organs may be used for other purposes such as medical research, a lack of confidence that medical teams would try as hard to save the life of a donor, concerns about leaving the body ‘intact’ after death and questioning the value being a donor.

Conclusions Low rates of registration as a kidney donor among ethnic minorities are not explained by specific cultural or religious barriers. More adequate explanations require a broader focus and greater understanding of ways in which self-identity as a minority group, cultural and religious beliefs and practices, and the social capital of communities, interact to shape responses.

Keywords: attitudes, ethnicity, health services, survey


   Introduction
TOP
 Introduction
Methods
 Results
 Discussion
 Conclusions
 Competing interest statement
 Contributors
 Ethics approval
 Acknowledgements
 References
 
People of African, Black Caribbean and South Asian heritage living in the UK are three to four times as likely to need a kidney transplant compared with the White population, reflecting their higher rates of diabetes and hypertension, both of which are major causes of end-stage renal failure.1 Organs matched by blood group and tissue type increase the chance of a successful outcome, with most suitable matches often being from the same ethnic group. However, organ donation by ethnic minorities continues to be lower than for the White population, accounting for 2% of donors but 8% of the UK population.2 Disproportionate numbers of ethnic minority patients are therefore awaiting transplants, much longer time spent on waiting lists, whereas human leucocyte antigen (HLA) matchgrades of transplants in ethnic minority patients are significantly inferior.2

Live donation can increase the supply of kidneys and in 2004–05 accounted for 27% of total kidney transplants. Cadaveric kidney donation however remains important, especially with the need for kidneys expected to rise steeply over the next decade.3

Most research examining attitudes and barriers to kidney donation among ethnic minorities has come from North America, where disparities between numbers of organ donors and recipients are particularly apparent in African Americans.4–10 Research in the UK mainly comprises a small number of qualitative studies among South Asian11,12 and Black African and Caribbean communities,13 together with small-scale surveys of particular ethnic groups (G. Anderson, unpublished data).14

This article reports the findings of the first large-scale survey that aimed to establish current knowledge of kidney donation and differences in attitudes and concerns between ethnic groups to inform future organ donation recruitment. It follows a national media campaigns in February 1999 focusing on the Asian community and in March 2002 on the African and Caribbean communities, which may have influenced awareness, knowledge and attitudes among these groups.


   Methods
TOP
 Introduction
 Methods
Results
 Discussion
 Conclusions
 Competing interest statement
 Contributors
 Ethics approval
 Acknowledgements
 References
 
A questionnaire survey was conducted among people attending four general practices in Lambeth Primary Care Trust (PCT) in south London. General practices were selected as providing an environment in which large numbers of people from the local population could easily be contacted, the study could be readily explained and consent forms completed. We also had no reason to believe that general practitioner (GP) attendance would influence responses to the questionnaire.

Lambeth PCT comprises an area with a high degree of deprivation; 18 of its 21 electoral wards are in the most deprived 20% of all wards in Britain. The population is ethnically diverse with 62.3% recorded as White, 25.8% as Black/Black British, 4.8% as Mixed, 4.6% as Asian/Asian British and 2.5% as Other ethnic groups.15 Areas with a high proportion of Black Caribbean and African patients were identified through the small area census statistics, and four study practices were selected from areas with at least 25% of the population recorded as Black or Black British.16 Between 40 and 43% of the resident populations of the wards in which the study practices were located were recorded as belonging to ethnic minorities, and 28 and 32% were recorded as Black or Black British.16 The study practices were all medium to large with 6–10 GPs.

A questionnaire was developed, informed by prior studies and six in-depth interviews with Black African and Caribbean respondents. The questionnaire was written in English and was kept brief to encourage completion. Questions related to knowledge and attitudes to registering as a kidney donor, with simple scale responses (e.g. strongly agree, agree, disagree, strongly disagree), plus a question on live donation. Respondents’ age, sex, education, occupation, religion and ethnicity (2001 census question) were also recorded. Questionnaires were piloted among 10 respondents to test comprehensibility, acceptability and completeness of coverage.

The main fieldwork took place over 12 weeks (July–September 2005). It was based on a convenience sample, with the fieldworker at each practice approaching adult patients (aged 18 years and over) in the waiting room. To increase the representation in the survey of males who are relatively low attenders and the numbers of people of Black Caribbean and Black African origin, the fieldworkers particularly targeted these groups. The survey therefore aimed to recruit sufficient people for analysis within these groups rather than providing a representative sample of the total population.

Patients were asked to sign and date the consent form before filling out the questionnaire. The confidential and anonymous nature of the questionnaire was emphasized, particularly when advising on the consent form. They were informed that they could complete the questionnaire at home and send it back and were offered a reply-paid envelope.

For patients who declined to take part, their age group (18–50 and 50+ years) and ethnicity were recorded (assessed by fieldworker) and the reason for refusing.

The sample size was originally planned to compare Black Caribbean respondents (the largest ethnic minority in the inner London study area) with other respondents. We aimed to recruit at least 1000 subjects, of whom we anticipated that at least 250 would be Black Caribbean. This was designed to achieve 80% power at the 5% significance level to detect a difference of more than 10% in the prevalence of a given barrier to donation.

Questionnaire responses were compared between ethnic groups using logistic regression, adjusting for age (as a continuous variable), gender and level of education (secondary or lower, further commercial/technical or university/polytechnic). The questions on whether an intact body is needed after death and whether organ donation is acceptable to the respondent’s religious beliefs were further analysed according to religion (Christian, Muslim, no religion, other religion). Ethnic group was divided into seven categories: White, Black Caribbean, Black African, Asian (comprising Indian, Pakistani, Bangladeshi and other Asian backgrounds), Mixed, Other Black and Other groups. Because the last four of these represent potentially diverse groups, we focused our analysis on White, Black Caribbean and Black African respondents. P-values reported here compare these three groups only, but for completeness we also present odds ratios (OR) and confidence intervals (CI) for all the ethnic groups relative to White respondents in Table 1.


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  		Table 1 Knowledge and attitudes to kidney donation by ethnic group

 

Bonferroni corrections were applied to allow for multiple testing. For the questionnaire items relating to knowledge, general attitudes, specific concerns and attitudes to live donation (21 in total) and for which we hypothesized that there would be more barriers to organ donation among non-White ethnic groups, a result was taken to be statistically significant if P < 0.05/21. For the seven sources of information on the current, urgent need for kidney donors, for which there was no specific prior hypothesis, a result was taken to be statistically significant if P < 0.05/7. For other comparisons, a result was taken to be statistically significant if P < 0.05.

All analyses were performed using Stata 9.17


   Results
TOP
 Introduction
 Methods
 Results
Discussion
 Conclusions
 Competing interest statement
 Contributors
 Ethics approval
 Acknowledgements
 References
 
Respondents
Of the 1903 patients approached at the four study practices, 1606 (84.4%) agreed to take part. Main reasons for refusal were: not interested or saying they were too old (100), feeling too ill (60), against donation or signing consent form (42), being in a rush (32) and difficulties due to poor English, literacy or lack of glasses (41). Twenty-two failed to return the questionnaire by post.

A total of 1536 (95.7%) questionnaires distributed were fully completed. Sixty-four were partially completed due to patients being called for their consultation and excluded from the analysis. Altogether, 808 (52.6%) respondents were self-classified as "White", 338 (22.0%) as Black Caribbean, 192 (12.5%) as Black African and 33 (2.1%) as Asian (Indian, Pakistani, Bangladeshi and other Asian), with other ethnic minorities and people of mixed race comprising 165 (10.7%) ( Table 2). This targeted approach led to a slight under-representation of White respondents and slight over-representation of Black Caribbean and Black African respondents compared with the population of Lambeth PCT, whereas men remained relatively under-represented in the sample.17 However, responses were analysed by ethnic group adjusted for age, sex and level of education rather than employed to assess prevalence in the population.


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  		Table 2 Characteristics of White, Black Caribbean and Black African respondents*

 

Knowledge
Four questions were asked about general knowledge of kidney donation. Table 1 shows the adjusted odds ratios for ethnic groups (White as reference category).

The adjusted odds ratios were significantly different for three statements: respondents from ethnic minorities were less likely to be registered on the NHS organ donor register or to carry a donor card (81.8% of White, 97.9% of Black Caribbean, 98.4% of Black African); they were less likely to be aware that it was possible to leave your kidneys for transplant in somebody else after death (5.6% of White, 13.4% of Black Caribbean, 16.9% of Black African); and among those aware of the possibility of leaving their kidneys for transplant, differing proportions felt poorly informed about registering (35.1% of White, 45.9% of Black Caribbean, 39.1% of Black African respondents). There were no differences in the proportion that knew someone who had received or was waiting to receive a kidney.

General attitudes
Five questions examined respondents’ general attitudes to registering as a kidney donor. The odds ratios identified significant differences among groups for each statement, with members of minority groups showing less-favourable attitudes (Table 1).

Among those who were aware of the possibility of leaving their kidneys for transplant, there were differences in the proportions who had ‘never’ thought about donating their kidneys after death (19.4% White, 54.5% Black Caribbean, and 55.8% Black African respondents), and in the proportions who would ‘not be willing’ to register as a kidney donor (13.7% White, 31.2% Black Caribbean, and 39.0% Black African respondents). There were differences among those aware of the possibility of leaving their kidneys for transplant in the proportions who had ‘never’ discussed donating their kidneys with a partner, family member or friend (55.2% White, 79.6% Black Caribbean, and 86.8% Black African respondents). For those who had discussed with others, these other people’s views were generally identified as supportive or mixed rather than negative.

Respondents were informed on the questionnaire that, ‘In some countries it is lawful to take kidneys from any adult who has just died, unless that person had specifically forbidden it while they were alive’, and asked whether they would oppose such an opt-out system in the UK. This was opposed by 27% of White respondents, by 46.2% of Black Caribbean and 36.8% of African respondents.

Specific concerns
A series of ten questions comprised statements about previously identified barriers to registration, with responses on a 5-point scale (strongly agree, agree, disagree, strongly disagree and don’t know). The adjusted odds ratios for responses are given (Table 1) and the percentages agreeing/disagreeing with each statement (Table 3).


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  		Table 3 Prevalence of specific concerns about kidney donation following death

 

Responses indicated that concerns were shared across groups but were significantly more prevalent among members of ethnic minorities. In particular, relatively high proportions of groups were concerned that donated organs might be used without consent for other purposes like medical research and felt that registration and carrying a donor card was like ‘tempting ones own death’.

The belief that ‘an intact body is needed after your death’ was more common among minority groups, and the difference remained significant after also adjusting for religion (Black Caribbean OR = 2.8, 95% CI 2.0–3.8; Black African OR = 4.7, 95% CI 3.1–7.0; P < 0.001).

Ethnic groups also differed in the proportions disagreeing with the statement ‘donating my organs is acceptable to my religious beliefs’ (5.0% of White, 18.9% of Black Caribbean and 19.2% of Black African respondents). This difference remained significant after also adjusting for religion (Black Caribbean OR = 2.8, 95% CI 2.0–3.9; Black African OR = 5.5, 95% CI 3.7–8.2; P < 0.001). The effect of religion was itself significant after adjusting for ethnic group (with Christian as the reference category: Muslim OR = 3.3, 95% CI 1.7–6.5; no religion OR = 1.0, 95% CI 0.6–1.5; other religion OR = 1.8, 95% CI 0.8–3.8; P = 0.004).

About one-quarter of Black Caribbean and Black African respondents disagreed with the statement that donating their organs on their death was a good thing to do, whereas only 4% of White respondents disagreed. Even among respondents who had no objections on the grounds of their religious belief and who disagreed with the statement that an intact body was needed after death, there were still differences between the ethnic groups in the proportions disagreeing that donating their organs was a good thing to do (1.5% of White, 13.3% of Black Caribbean and 13.6% of Black African respondents; P < 0.001).

Live donation
Respondents were informed that it is becoming possible to donate one of your kidneys while you are still alive to a close relative and were asked, ‘If a close relative or friend of yours needed a kidney transplant would you be willing to consider becoming a live donor?’ The proportions that might be willing in the case of a young child needing a transplant, or an adult, did not differ significantly between ethnic groups (Table 1).

Exposure to information from different sources
Questions on whether respondents had read or heard about an urgent need for kidney donors from various sources indicated that White respondents were significantly more likely than other ethnic groups not to have heard anything about this need, with differences evident in terms of information from television, radio, magazine and leaflets/posters, respectively (Table 4).


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  		Table 4 Differences between ethnic groups in exposure to information about the urgent need for more kidney donors

 


   Discussion
TOP
 Introduction
 Methods
 Results
 Discussion
Conclusions
 Competing interest statement
 Contributors
 Ethics approval
 Acknowledgements
 References
 
Main findings of this study
The survey identified considerable similarities among minority ethnic groups in their attitudes to organ donation and significant differences from ‘ White’ respondents. Respondents from ethnic minorities were however significantly more aware compared with White respondents of the urgent need for kidney donors, possibly reflecting the success of campaigns in 1999 and 2002 that focused on the Asian and Black populations, respectively. Overall, at least 83% of respondents in each ethnic minority were aware of the possibility of leaving your kidneys for transplant after your death, and there was no evidence of differences among ethnic groups in the proportions who felt poorly informed about registering among those who were aware of the possibility of leaving their kidneys for transplant. However, increased knowledge does not necessarily translate into changes in attitudes or behaviours, with attitudinal responses being consistently and significantly more negative among ethnic minorities.

Religion, particularly the Muslim faith, was associated with increased concerns about organ donation. This is despite the declaration by leaders from all the major faith groups in the UK that there are no religious prohibitions against organ donation.2 However, respondents may not have been aware of these views. There are also differences between beliefs and practice, with cadaveric donation perceived by many Muslims as disrupting their honouring of the dead.18 The significant association of belief in the need for an intact body with membership of an ethnic minority held after adjusting for religion, suggesting that religion is only one of several influences.

What is already known on this topic
A major finding from previous research in the UK has been the problem of a lack of information (G. Anderson, unpublished data).12,13 Individual studies have also highlighted attitudinal barriers, such as mistrust in medical professionals and fear about the effects of carrying a donor card on attempts to resuscitate them following an accident, concerns about tempting fate and concerns about having an ‘intact’ body at death (G. Anderson, unpublished data).11–14

What this study adds
Recent media campaigns appear to have increased awareness of kidney donor registration and of the need for organ donation among ethnic minorities in the UK. However, negative attitudes to registration as a donor were a consistent feature of responses among all ethnic minorities rather than been explained by one or two specific barriers. Each potential attitudinal barrier was however shared by a proportion of the White respondents, particularly concerns about the use of organs for medical research, concerns that medical teams may not try as hard to save a person who has agreed to donate and worries about ‘tempting fate’. These statements therefore appear to identify widespread beliefs in the population.

A generalized lack of trust in health systems and health professionals19 and worries about the use of donated organs may have been influenced by recent media reporting of malpractice in the use of children’s organs at Alder Hay Hospital.20 However, the greater concerns of ethnic minority groups may also reflect their marginalized positions and location in relatively mobile, ethnically mixed areas of south London that are often characterized by social disadvantage and high unemployment. Despite strong levels of ‘bonding’ social capital in terms of the dense network of ties that hold families and groups together, one explanation for people’s unwillingness to donate their organs which involves gifting outside one’s immediate community may be the existence of low levels of ‘bridging’ social capital, defined by Putnam21 as the looser ties that connect acquaintances from different social groups.22,23 Reluctance to donate outside one’s immediate community may also reflect cultural differences in the way ‘society’ is conceived, with some cultures not identifying with the abstract and external conception of society that the system of organ donation propagates. Another explanation may be the difficult and extraordinary circumstances that surround cadaveric organ donation in general, with death heightening the need to respect and reaffirm particular aspects of identity and group belonging, thus emphasizing group belonging, continuity and kinship and limiting exchanges with outsiders. These beliefs and feelings are more likely to both reduce individual’s registration as a donor and also form important influences on relatives in agreeing or denying consent for donation by family members, with the refusal rate for families of potential donors from ethnic minorities in the UK being twice that for White potential donors.24

Limitations of this study
The survey was conducted among GP attenders but did not involve general practice staff, and it is therefore unlikely that the primary care setting would have significantly influenced responses. The non-response rate was however higher among ethnic minorities (31 versus 9% for White patients), with 25% of the Black Caribbean and Black African attenders approached declining to participate. This may reflect both the fieldworkers targeting people from minority ethnic groups and more negative attitudes to organ donation among these groups. The ethnicity of the fieldworker (three White and one West African) was not significantly associated with response rates.

Although the survey reveals widespread negative attitudes to registration as a donor among ethnic minorities, it fails to accurately represent how far these attitudes are tempered by ambivalence on the topic. Previous qualitative studies (G. Anderson, unpublished data)11,12 and our pilot interviews show that many people are in fact supportive of the act of humanity involved in organ donation, while also ambivalent or undecided on whether they themselves would be willing to donate.


   Conclusions
TOP
 Introduction
 Methods
 Results
 Discussion
 Conclusions
Competing interest statement
 Contributors
 Ethics approval
 Acknowledgements
 References
 
Negative attitudes to registration as a donor among ethnic minorities identified through a community survey involved multiple issues rather than a single barrier or need for information. More adequate explanations of low donation rates among ethnic minorities therefore require a broader focus to achieve a greater understanding of ways in which self-identity as a minority group, cultural and religious beliefs and practices and the social capital of communities, interact to shape responses. Leadership and role models from within the ethnic minority communities are also of importance to increase trust and gain greater acceptance of organ donation among minority groups.


   Competing interest statement
TOP
 Introduction
 Methods
 Results
 Discussion
 Conclusions
 Competing interest statement
Contributors
 Ethics approval
 Acknowledgements
 References
 
None of the authors have competing interests.


   Contributors
TOP
 Introduction
 Methods
 Results
 Discussion
 Conclusions
 Competing interest statement
 Contributors
Ethics approval
 Acknowledgements
 References
 
MM and RJ designed the project; all authors contributed to the questionnaire; MM and MMab organised the survey; RH undertook the statistical analysis; MM was responsible for initial and subsequent drafts with all authors contributing; MM is guarantor.


   Ethics approval
TOP
 Introduction
 Methods
 Results
 Discussion
 Conclusions
 Competing interest statement
 Contributors
 Ethics approval
Acknowledgements
 References
 
The study received ethical approval from Guy’s Hospital Research Ethics Committee and Research Governance approval from Lambeth and Southwark Primary Care Trusts.


   Acknowledgements
TOP
 Introduction
 Methods
 Results
 Discussion
 Conclusions
 Competing interest statement
 Contributors
 Ethics approval
 Acknowledgements
References
 
We thank the following people for commenting on the questionnaire: Cynthia Davis (South-East London Renal Services Co-ordination), Dr Paul Donohoe (Renal Services, King’s College Hospital), Dr Jamie Ferguson (Lambeth Primary Care Trust) and Dr Chris Rudge (UK Transplant).

We are grateful to Sally Wood for coordinating the survey, to Miofa Ngoke, Joanna Smeeton and Alison Webster for administering the survey and to the staff and patients at the four study practices.

Funding
Funding received from the Centre for Caribbean Health, King’s College London that is supported by Department of Health, institutional and voluntary funds.


   References
TOP
 Introduction
 Methods
 Results
 Discussion
 Conclusions
 Competing interest statement
 Contributors
 Ethics approval
 Acknowledgements
 References
 

  1. Roderick PJ, Raleigh VS, Hallam L et al. The need and demand for renal replacement therapy among ethnic minorities in England. J Epidemiol Community Health 1996;50(334):339.
  2. Rudge CJ, Johnson RJ, O’Neil J et al. Renal Transplantation for Patients from Ethnic Minorities [Abstract]. www.uktransplant.org.uk/ukt/statistics/presentations/pdfs/ethnicity.pdf (12 May 2006, date last accessed).
  3. Department of Health. Saving Lives, Valuing Donors – a Transplant Framework for England. London: Department of Health 2003.
  4. Callender CO, Miles PV. Obstacles to organ donation in ethnic minorities. Pediatr Transplant 2001;5:383–5.[CrossRef][Web of Science][Medline]
  5. Kopfman JE, Smith SW, Morrison K et al. Influence of race on cognitive and affective reactions to organ donation messages. Transplant Proc 2002;34:3035–41.[CrossRef][Web of Science][Medline]
  6. McNamara P, Guadagagnoli E, Evanisko MJ. Correlates of support for organ donation among three ethnic groups. Clin Transplant 1999;13:45–50.[CrossRef][Web of Science][Medline]
  7. Park M. A statewide assessment of attitudes, beliefs and behaviours among blacks toward donation. J Transpl Coord 1998;8(1):25–9.[Medline]
  8. Siminoff L, Renee L, Robert A. Comparison of black and white families experiences and perceptions regarding organ donation requests. Crit Care Med 2003;31(1):146–51.[CrossRef][Web of Science][Medline]
  9. Spigner E, Weaver M, Pineda M et al. Race/ethnic based opinions on organ donation and transplantation among teens. Transplant Proc 1999;31:1347–8.[CrossRef][Web of Science][Medline]
  10. Verble M, Bowen GR, Kay N et al. A multi-ethnic study of the relationship between fears and concerns and refusal rates. Prog Transplant 2002;12(3):185–90.[Medline]
  11. Darr A, Randhawa G. Awareness and attitudes towards organ donation and transplantation among the Asian population: a preliminary survey in Luton, UK. Transpl Int 1999;12(5):365–71.[CrossRef][Web of Science][Medline]
  12. Exeley C, Sim J, Reid N et al. Attitudes and beliefs within the Sikh community regarding organ donation: a pilot study. Soc Sci Med 1996;43(1):23–8.[CrossRef][Web of Science][Medline]
  13. Davis C, Randhawa G. ‘Don’t know enough about it!’ – Awareness and attitudes towards organ donation and transplantation among the black Caribbean and black African population in Lambeth, Southwark and Lewisham, UK. Transplantation 2004;78(3):420–5.[CrossRef][Web of Science][Medline]
  14. Randhawa G. An exploratory study examining the influence of religion on attitudes towards organ donation among the Asian population in Luton, UK. Nephrol Dial Transplant 1998;13:1949–54.[Abstract/Free Full Text]
  15. Director of Public Health. Lambeth Primary Care Trust. Annual Health Report 2004–05, Promoting Health Equity. Lambeth PCT.
  16. http://www.neighbourhood.statistics.gov.uk/dissemination (18 May 2006, date last accessed).
  17. Stata 9. Stata Corporation. College Station, Texas, USA.
  18. Hayward C, Madhill A. The meanings of organ donation. Muslims of Pakistani origin and white English nationals living in north England. Soc Sci Med 2003;57(3):389–401.[CrossRef][Web of Science][Medline]
  19. Calnan M, Rowe R. Trust relations in the ‘new’ NHS: theoretical and methodological challenges. Paper presented at ESRC conference, Taking Stock of Trust. London: London School of Economics, 2005.
  20. The Report of The Royal Liverpool Children’s Inquiry 2001. http//www.rlcinquiry.org.uk (12 May 2006, date last accessed).
  21. Putnam R. Bowling Alone: the Collapse and Revival of American Community. New York: Simon and Schuster, 2000.
  22. Stack C. All Our Kin. New York: Harper & Row, 1974.
  23. Fernandez-Kelly P. Social and cultural capital in the urban ghetto. In: Portes A (ed). The Economic Sociology of Immigration: Essays on Networks, Ethnicity and Entrepreneurship. New York: Russell Sage Foundation, 1995.
  24. Barber K, Falvey S, Hamilton C et al. Potential for organ donation in the United Kingdom: audit of intensive care records. BMJ 2006;332:1124–7.[Abstract/Free Full Text]

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