Disparities in Organ Transplants in the US
- Ronli Lai & Jasmine Zhou
- Mar 7, 2024
- 2 min read
Did you know: On average, Black patients in the US in need of organ transplants wait one year longer than White patients?
The disparities in access to organ transplantation are based on social determinants of health such as race, income, education, geography, insurance status, and health literacy. Organ transplants are the preferred treatment for end-stage organ disease, but many patients with such conditions are not placed on the transplant waiting list. This limitation, coupled with the scarcity of available organs, leads to over 100,000 deaths annually in the United States.
The organ donor and transplant system in the United States is complex, comprising numerous steps, guidelines, and decisions. Inequities exist within this system, affecting both the donor and recipient sides. As of June 2022, 105,922 people in the U.S. needed an organ transplant, with 10,286 donors facilitating 20,663 transplants. The process involves donor referral, evaluation, and matching through organizations like the United Network for Organ Sharing (UNOS).
Despite UNOS claiming no role for personal characteristics in transplant priority, social factors affect access. Financial barriers, including proof of covering 20% of transplant costs, hinder access. The estimated charges for a heart transplant alone can range from $69,400 to $276,480. Post-transplant costs, such as medications and follow-up, add to the financial burden.
One review encompassed 16,643 studies, with 227 meeting the inclusion criteria. These studies focused on various aspects, including referral for transplantation (34 studies), transplant selection processes (82 studies), living donors (50 studies), and waitlist management (61 studies). Thoracic organs (heart, lung) were covered in 15 studies, abdominal organs (kidney, liver, pancreas) in 209 studies, and three studies involved multiple organs. Findings revealed that racial and ethnic minorities, women, and individuals with lower socioeconomic status were less likely to be referred, evaluated, and added to the waiting list for organ transplant (Park et al, 2022).
Racial disparities persist, with Black patients 25% less likely to be considered for the UNOS list in kidney transplantation. Unconscious provider bias and systemic biases, such as racial adjustments in calculations like estimated glomerular filtration rate (eGFR), contribute to these disparities. Due to flawed research suggesting higher muscle mass in Black individuals, the interpretation of eGFR made their kidney function appear up to 16% better than their White counterparts, implying longer-lasting kidney function. Private insurance holders are more likely to be referred for transplants than Medicaid recipients, and gender inequities also exist in transplant care.
Efforts to address disparities include initiatives by organizations like the National Kidney Foundation to remove race from eGFR calculations. Additionally, studies suggest that increased knowledge, trust, and communication between patients and providers may help overcome barriers to care. Ultimately, the aim is to establish an equitable system that provides all eligible patients with equal access to transplant opportunities. Despite the significant benefits of organ transplants, the current system's disparities necessitate comprehensive attention and reform within the healthcare system.
Promoting shared decision-making with patients, enhancing public education on organ transplantation, amplifying the voices of those confronting disparities, and aligning healthcare providers with the overarching goal of equity will help address the current disparities involved in organ transplantation.
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