USA Medical Discrimination
ironjustice
Liver Transplantation
Article Date: 01 Sep 2009 - 6:00 PDT
Patient race, gender and insurance status influence decisions about
who will go on to receive liver transplants, according to a University
of Pittsburgh School of Medicine study. Available online and published
in the September issue of the American Journal of Transplantation, the
study indicates that women, blacks and patients with Medicare who are
in end-stage liver disease are less likely to be referred and
evaluated for liver transplantation.
"There currently is no comprehensive oversight of liver disease
patients as they go through evaluation, referral and are put on a
waitlist for transplantation," said Cindy L. Bryce, Ph.D., study lead
author and associate professor of medicine, University of Pittsburgh.
"We know what happens once patients are selected for transplantation
since they are closely monitored, but what happens prior to this point
is fairly invisible. Ours is the first major study to look at whether
everyone with liver-related conditions has a fair shot of being
considered for transplantation, and points out that many patients are
being excluded from this process."
The study, which followed 144,507 patients hospitalized in
Pennsylvania with liver-related conditions, sought to determine
whether any potential barriers exist at the referral and listing steps
in the transplantation process. Dr. Bryce and colleagues found that
4,361 of these patients underwent transplant evaluation. Of these,
3,071 were waitlisted and 1,537 went on to transplantation. Patients
were significantly less likely to undergo evaluation, waitlisting and
eventual transplantation if they were women, black or covered by
Medicare.
Disparities were especially apparent in the early stages of the
process when evaluation and listing occurs - 61 percent of men were
evaluated for transplantation compared to 39 percent of women; 73.8
percent of whites were evaluated compared to 8.6 percent of blacks;
and 62 percent of patients with commercial insurance were evaluated
compared to 4.7 percent with Medicare only.
"While our study was not designed to identify causes for these
disparities, current practices for identifying and referring liver
disease patients for transplantation should be made more transparent,"
said Dr. Bryce. "Although we face a worsening gap in the supply and
demand for organs for liver transplantation, race, gender and
insurance status should not be factors that preclude patients from
being evaluated for transplantation."
Co-authors of the study include Derek Angus, M.D., Robert Arnold,
M.D., Chung-Chou Ho Chang, M.D., Max Farrell, B.S., and Mark S.
Roberts, M.D., University of Pittsburgh School of Medicine; Cosme
Manzarbeitia, M.D., and Ignazio Marino, M.D., Thomas Jefferson
University.
The study was funded by the National Institute of Diabetes and
Digestive and Kidney Diseases at the National Institutes of Health.
Source:
Clare Collins
University of Pittsburgh Schools of the Health Sciences
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