Wealth Trumps Need in Organ Transplant Decisions

Patients simultaneously registering at multiple centers had higher transplant rates, lower death rates waiting for a transplant, and greater income.

In what will come as no surprise, recent research indicates that the wealthiest of patients have an advantage over the sickest of patients in receiving an organ transplant.

A study presented at the American Heart Association Scientific Sessions 2015 found that registering with multiple organ transplant centers provides a benefit to wealthy patients over patients with the greatest medical need.

An analysis of the national organ donor database from 2000 to 2013 showed patients who simultaneously registered at multiple centers had higher transplant rates, lower death rates waiting for a transplant, had greater income, and are more likely to be insured.

"It's an effective approach to address long waiting times and the shortage of organs available for the increasing demand among transplant candidates. But it undermines a bedrock principle of organ transplantation, which is that the sickest people should be transplanted first," said lead author Raymond Givens, MD, PhD, advanced heart failure and transplant fellow at Columbia University Medical Center in New York. "We firmly believe the multiple listing policy needs to be reconsidered."

An analysis of the United Network for Organ Sharing (UNOS) database zeroed in on adult patients who were first-time, single-organ candidates for heart, lung, liver, or kidney transplants. The UNOS is a nonprofit managing the organ transplant system in the United States under federal contract.

Network policy allows organ transplant candidates to simultaneously register at multiple transplant centers.

During the study duration, researchers found 33,928 patients on a heart transplant wait list, of which 2% were multiple-listed; 24,633 patients on a lung transplant wait list, of which 3.4% were multiple-listed; 103,332 patients on a liver transplant wait list, of which 6% were multiple-listed; and 223,644 patients on a kidney transplant wait list, of which 12% were multiple-listed.

The findings showed higher income patients with money for travel, temporary housing, and to cover additional costs for multiple listings not covered by health insurance have a significant advantage over less wealthy patients.

Lower income patients in state-run Medicaid may not have the financial means to register at a center in a different state, the study noted.

"The main issue is supply and demand," Dr. Givens said. "The need for donor organs increases yearly; the supply does not. We really need more people to volunteer to donate their organs. That would relieve a lot of the strain on these inequalities. From a policy perspective, there is a need to redesign the system of organ allocation to ensure fairer access."