Blacks and poor individuals are more likely to be donors while whites and wealthier individuals are more likely to be recipients of many types of transplant organs, according to a new study in the November 2004 issue of the American Journal of Medicine. The study was conducted by Ashwini Sehgal, M.D., director of the Center for Reducing Health Disparities at Case Western Reserve University and a nephrologist at MetroHealth Medical Center in Cleveland, Ohio.

The investigation examined over 100,000 transplants performed in the United States from 1996 to 2001 and found that blacks were more likely to be donors while whites were more likely to be recipients for 6 of 8 types of deceased donor transplants (heart-lung, intestine, kidney-pancreas, liver, lung, and pancreas). Poor individuals were more likely to be donors while wealthier individuals were more likely to be recipients for 7 of 8 types of deceased donor transplants.

Transplantation is the best treatment for many types of permanent organ failure. Organs for transplantation may come from deceased donors (brain dead individuals whose families have consented to donate) or from living donors (usually close relatives with compatible blood and tissue types). A scarcity of both deceased and living donors means that most patients with organ failure never receive transplants. While payment to donors of any kind is currently illegal in the United States, periodic efforts are made to allow financial incentives as a way to encourage donation.

This study raises concerns about efforts to offer financial incentives since minorities and the poor may be disproportionately affected by such incentives.

"There are already widespread disparities in who donates and who benefits from organ transplantation. Adding financial incentives to the system might make these race and income disparities even worse," said Sehgal.

Kidney transplants were an exception to the general pattern. Blacks and poor people were more likely to receive than donate kidneys. This is probably due to two factors. First, Medicare pays for virtually all treatment for permanent kidney failure in the United States, regardless of patient age. This means blacks and poor individuals have access to medical care, including kidney transplantation. Second, blacks and poor people have much higher rates of kidney failure than whites and wealthier individuals.

The main finding for living donor transplants involved spousal transplants. Wives were twice as likely to donate to husbands than husbands to wives.

Sehgal emphasized the need to understand the causes of disparities in donating and receiving transplant organs. Some disparities may be unavoidable or even desirable. For example, ensuring a good tissue type match improves survival of transplanted organs but may make it harder for blacks to receive organs. Disparities that are both avoidable and undesirable are more concerning. For example, lack of health insurance may act as a barrier to transplantation among blacks and the poor.

Contact: George Stamatis
Case Western Reserve University

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