Wealthier Patients Have an Edge in Organ Transplantation

Registering with multiple organ transplant centers may give wealthier patients an edge over less affluent patients who may be more deserving of a transplant.

Data presented at the American Heart Association (AHA) 2015 Scientific Sessions revealed that, statistically, those who simultaneously listed at multiple centers had higher transplant rates and lower death rates while waiting.

In theory, the act of multiple listing is an effective method to address organ shortages. However, as this would be likely done by wealthy, privately insured individuals, this would significantly challenge the idea of transplanting the sickest patients first.

Raymond Givens, MD, PhD, study lead author and advanced heart failure and transplant fellow, Columbia University Medical Center, NY, NY, said, “It’s an effective approach to 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. We firmly believe the multiple listing policy needs to be reconsidered.”

The team of researchers analyzed the United Network for Organ Sharing (UNOS) database between 2000 and 2013 and identified 33,928 patients waiting for a heart transplant (2% were multiple-listed), 24,633 individuals awaiting 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).

The data suggested an advantage for wealthier patients with the resources for travel, temporary housing, and other costs of multiple listing not covered by health insurance.

Patients with state-run Medicaid, however, typically have lower incomes and thus may not even have the option to list themselves at an out-of-state center.

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