Wealthy people appear to have an edge when it comes to organ transplants, according to research presented last month at the American Heart Association's Scientific Sessions 2015. How is this true? Because these well-off patients register with more than one transplant center.
Researchers with Columbia University Medical Center reviewed information contained in the national database of organ donors, United Network for Organ Sharing (UNOS). UNOS, the nonprofit organization under federal contract to manage the organ transplant system in the United States, lets organ transplant candidates register at multiple locations.
The study found that people who listed at more than one location had higher transplant rates and lower death rates as they waited for an organ. These patients were also generally wealthier and carried insurance.
Listing at more than one location is effective for addressing long wait times and organ availability. The concern is that a multiple listing can potentially delay the transplant for someone with a lower priority at the second location.
Traditionally, the sickest person on the wait list is usually the first in line for a heart, lung or liver donation. In kidney donations, the patient who has been on the list the longest has priority because dialysis can sustain these patients.
The researchers analyzed information in UNOS to identify adult patients listed as first-time candidates for single-organ heart, lung, kidney or liver transplants, and determine how many had listed in multiple locations.
The investigators found that, between the years 2000 and 2013:
- 33,928 patients waited for a heart transplant — 2 percent were multiple-listed
- 24,633 patients waited for a lung transplant — 3.4 percent multiple-listed
- 103,332 patients waited for a liver transplant — 6 percent multiple-listed
- 223,644 patients waited for a kidney transplant — 12 percent multiple-listed
The scientists also discovered that, on average, patients who registered at multiple locations lived in zip codes with a median income of $25,000 higher in comparison with patients who listed at a single location. Furthermore, those who listed a several locations had higher eventual transplant rates — up to two times more frequent — and lower rates of death while waiting for their transplant.
The results suggest wealthier patients have an advantage in that they have the money for temporary housing, travel and other expenses not covered by insurance. Less wealthy patients, especially those with state-run Medicaid, typically have lower incomes and therefore cannot afford the travel necessary to join the transplant list in another state.
The researchers also found the extra lists had shorter wait times, at least for candidates awaiting heart transplants. The median wait time for a new heart was 151 days on the original list but only 105 days on the second list. The scientists have not yet investigated the wait times for liver, lungs and kidney transplants to compare between original and secondary lists.
Supply and demand is a primary issue in organ transplant, with the need for donor organs increasing yearly while the supply remains constant. Increasing volunteer organ donation would help relieve supply issues, but the research results suggest a need to redesign the organ allocation system to ensure fairer access for all.
The study, funded by the International Society for Heart & Lung Transplantation and the Heart Failure Society of America, has not yet been peer reviewed or published in a scientific or trade journal.
