Organ Procurement and Transplantation Assessing Current Policies and the Potential Impact of the DHHS Final Rule (1999) / Chapter Skim
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3 Access to Transplantation
3 Access to Transplantation
Pages 39-48
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From page 39... ...
Therefore, the committee's findings are based on a small number of studies, most pertaining to kidney transplants, that report differences between white and African American populations or income classes and on the committee's own analysis of patient waiting times on liver transplantation lists. The published evidence reveals that African American and low-income kidney patients of all racial and ethnic groups are slower to be placed on waiting lists and, once on a waiting list, African Americans do not receive kidney transplants as quickly as whites.
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From page 40... ...
These results indicate that the racial disparity in transplantation observed among patients on waiting lists for kidneys is not observed among patients waiting for livers. It does appear, however, that African Americans enter the list and receive liver transplants when they are sicker, relative to other racial groups.
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From page 41... ...
, among others, have identified socioeconomic status as a major factor in determining whether kidney patients are able to get on a waiting list, accounting for one-third of the disparity between African Americans and whites. Patients with annual incomes greater than $40,000 were twice as likely to be added to a waiting list within 2 years of their first end-stage renal disease service as those with incomes less than $10,000 per year, and African Americans were disproportionately represented in the latter group.
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From page 42... ...
They did find that patient attitudes toward transplantation constituted a major factor in the racial disparities in both placement on a waiting list and receipt of a transplant. African Americans were less positive about the medical and health outcomes of kidney transplantation than whites and much more likely to express religious objections to transplantation, as well as uneasiness about having a dead person's organ in one's own body.
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From page 43... ...
The view that low-volume liver transplant centers would be forced to close if the Final Rule were implemented is apparently grounded on the assumption that since such centers currently have fewer status 1 or status 2A patients on their waiting lists, or have patients with shorter accumulated waiting times, a broader sharing arrangement that gave priority to status 1 and status 2A patients, and also took waiting time into account, would result in smaller centers' receiving fewer donated organs, with a corresponding decrease in the economic viability of these centers. The committee was not persuaded by this argument.
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From page 44... ...
To the contrary, they suggested that the consolidation of current waiting lists into larger regional lists might help reduce disparities in access by giving waiting list patients access to a wider range of donor organs. Ozminkowski's conclusion that distance from the patient's residence to the transplant center did not affect access would appear to be contradicted by TuttleNewhall and colleagues (1997)
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From page 45... ...
The committee reviewed current state Medicaid policies regarding payments for transplantation to determine whether potential transplant recipients who are eligible for Medicaid might be adversely affected by changes in the current transplantation system proposed under the Final Rule. Again, the major concern expressed by opponents of the Final Rule is that it would result in the closure of smaller transplant centers and would decrease access on the part of those who depend on Medicaid to pay for transplants.
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From page 46... ...
However, if there is no center in the state, payment will be made for transportation to and treatment in the nearest available transplant center. Thus, it appears that broader organ sharing resulting from implementation of the Final Rule is not likely to have a significant adverse effect on those who are dependent on Medicaid for their health care.
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From page 47... ...
ACCESS TO TRANSPLANTATION 47 The larger problems of equitable access to transplantation occur prior to a patient being put on a waiting list for a transplant; they take the form of inadequate health insurance coverage and inadequate access to primary care, proper diagnosis and treatment, and referral for transplant evaluation.
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From page 48... ...
PUBLIC AND PROFESSIONAL ATTITUDES There are few data available to determine with confidence the effects of organ allocation policies on donation rates. However, a July 1998 Gallup Poll conducted for the National Transplant Action Committee examined adults' attitudes toward organ allocation policies and their effects on organ donation (Gallup Organization, Inc., 1998~.
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