Wealthiest patients may have edge over sickest in organ transplants


The ability to register with more than one organ transplant centre seems to increase a patient’s likelihood of receiving a transplant. According to research presented at the American Heart Association (AHA)’s Scientific Sessions, this can give an edge to wealthier patients who can afford to pay for travel, temporary housing and other associated costs, over the sickest.

Researches found that patients who were simultaneously registered at more than one centre had higher transplant rates, lover death rates while waiting, were wealthier and were more likely to be insured. The data was gathered from the national database of organ donors from 2000 to 2013.

“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,” says Raymond Givens, study lead author and 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.”

Researchers analysed the United Network for Organ Sharing (UNOS) database, identifying adult patients listed as first-time, single-organ candidates for either heart, lung, liver or kidney transplants. The network is a nonprofit that manages the U.S. organ transplant system under federal contract. UNOS policy allows organ transplant candidates to be listed at multiple centres simultaneously.

Between 2000 through 2013, researchers identified: 33,928 patients waiting for a heart transplant (2% were multiple-listed); 24,633 patients waiting for a lung transplant (3.4% multiple-listed); 103,332 patients waiting for a liver transplant (6% multiple-listed); and 223,644 patients waiting for a kidney transplant (12% multiple-listed).

These findings suggest an advantage for wealthier patients who have the money for travel, temporary housing and other costs of multiple listing that are not covered by health insurance, Givens said. Patients with state-run Medicaid generally have lower income and may not have the option to list themselves at a centre in a different state.  

“The main issue is supply and demand,” says Givens. “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.”