Posted on November 18, 2008

Uninsured Give but Rarely Receive Organs for Transplant


Posted by Vanessa Fuhrmans
Wall Street Journal Blog
November 18, 2008, 8:26 am

Call it the ultimate inequity in health care. A team of Harvard researchers finds that people without health insurance are about 20 times more likely to donate a liver or kidney than to receive one.

The results of the study, which appear in the current issue of International Journal of Health Services, looked at U.S. transplant patients in 2003. It found that 16.9% of organ donors had no health insurance at the time of hospitalization. But only 0.8% of transplant recipients were uninsured.

Why the stark unfairness? The study’s authors say the share of uninsured donors is roughly proportionate to the total uninsured population. But donors also tend to be younger adults, who also happen to go without coverage at higher rates than older people.

The problem is on the recipient side. If someone doesn’t have financial resources or insurance, few medical centers will consider that patient a transplant candidate, the authors say.

The study was triggered after its lead author, Andrew Herring, then a third-year medical student, cared for a 25-year-old uninsured day laborer at Cambridge Hospital in Boston in 2005. Suffering from advanced cardiomyopathy, or a severely inflamed heart, the patient could not get on a transplant list, in part because he wouldn’t have been able to pay for the expensive medications needed to support his recovery. He later died.

“What struck us was he was eligible to give but not receive an organ,” says Steffie Woolhandler, the study’s co-author who was Herring’s supervisor at the time. “Had he been in a car accident six months before, everyone would have been willing to harvest his organs.” She says she doesn’t blame doctors, who must follow explicit criteria to put patients on transplant lists, but an inequitable system.