Organ waiting list policy benefits the wealthy, study charges

Patients who can afford to get on multiple transplant lists more likely to survive

heart transplant

HEART OF THE MATTER  Allowing patients to get on waiting lists for organs at multiple centers may exacerbate transplant disparities.

Pamela Moore/iStockphoto

ORLANDO, Fla. — People in line for organ transplants gain an advantage by getting on the waiting lists at multiple centers. But that privilege appears to favor wealthier patients and may be exacerbating existing inequities in organ transplantation, according to data presented November 9 at the American Heart Association’s scientific sessions.

More than 122,000 people in the United States currently need a new heart, lung, kidney or other organ, according to the United Network for Organ Sharing. The nonprofit organization, which manages organ transplantation, allows patients to enroll on waiting lists at more than one center. The idea is that multiple listing helps patients overcome geographic disparities in the availability of organs.

But instead of leveling access, “this is a policy that exacerbates that disparity,” said Raymond Givens, a cardiologist from Columbia University Medical Center. In his analysis of national transplant data, people with multiple listings were more likely to receive a transplant and have lower death rates. For example, 18.6 percent of patients on a single list for a kidney transplant died waiting, compared with 10.8 percent of those on more than one list.

Givens also found that patients on multiple lists tended to have higher incomes and private insurance. To get on more than one list, a patient must be evaluated at each center, which requires the means for travel and lodging.

The multilist policy exists because patients want it, said UNOS spokesman Joel Newman. The organization has reconsidered the multiple listings policy three times in the organization’s history, he said. “We are always open to looking at it again.” 

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