Healthcare: Wealth may give advantage for getting new organ transplants

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ORLANDO, FLA. >> You can't buy hearts, kidneys or other organs but money can still help you get one.

Wealthy people are more likely to get on multiple waiting lists and score a transplant, and less likely to die while waiting for one, a new study finds.

The work confirms what many have long suspected — the rich have advantages even in a system designed to steer organs to the sickest patients and those who have waited longest. Wealthier people can better afford the tests and travel to get on more than one transplant center's waiting list, and the new study shows how much this pays off.

"Multiple-listed patients were more likely to get transplanted and less likely to die," said Dr. Raymond Givens at Columbia University Medical Center in New York.

"It's a rational thing to do" from an individual patient's point of view, but it raises fairness questions, and the policy should be reconsidered, he said.

He led the study and gave results last week at an American Heart Association conference in Orlando.

More than 122,000 Americans are wait-listed for an organ, including more than 100,000 who need kidneys. As of July, only 18,000 transplants have been done this year.

The United Network for Organ Sharing, or UNOS, the agency that runs the nation's transplant system under a government contract, assigns organs based on a formula that considers medical urgency, tissue type, distance from the donor, time spent on the waiting list and other factors.

UNOS has considered banning or limiting multiple listings three times, most recently in 2003, said spokesman Joel Newman. But some people think patients should be free to go wherever they want to improve their odds, and UNOS now requires that transplant centers tell them about this option.

Ability to travel helps

"It takes money and knowledge ... traveling can make a huge difference in how quickly you get an organ," said Robert Veatch, a medical ethicist at Georgetown University Medical Center and a longtime member of the UNOS ethics committee who thinks the policy should be changed.

"Steve Jobs is the classic example," he said. The former Apple chief was on a transplant list in Tennessee and received a new liver at a hospital there in 2009 even though he lived in California. It's not known if he was on more than one waiting list, however.

Patients on multiple lists often must pay for a new set of tests, which can range from $23,000 for a kidney to $51,000 for a heart, one study estimated, plus be able to get local housing or travel on short notice if an organ becomes available.

An Internet database— the Scientific Registry of Transplant Recipients — gives average wait times, success rates and other details on every transplant program in the nation.

Many people from New York, where organs are scarce, seek a second listing in California, where organs are more plentiful.

Steven Taibbi, 62, who lives in Huntington on New York's Long Island, is on a wait list for a heart at Columbia, but is seeking a second listing in Los Angeles. Taibbi, who once helped head an international charity for organ donation, said: "I'm decimating my retirement account to do this. I'm not a rich guy."

It can pay off, though. Givens and colleagues studied UNOS records from 2000 to 2013 and found that multiple-listed patients had higher transplant rates, lower death rates while waiting, were wealthier and were more likely to have private insurance.

Highlights:

• Multiple listing occurred among 2 percent of those seeking a heart, 6 percent seeking a liver and 12 percent seeking a kidney.

• Death rates while waiting for an organ were higher among those on a single list versus multiple ones: 12 percent versus 8 percent for those seeking a heart; 17 percent versus 12 percent for a liver, and 19 percent versus 11 percent for a kidney.

• Compared to people on just one list, multiple listers were younger (52 versus 54), more likely to have private insurance (59 percent versus 51 percent) and less likely to be covered by Medicaid (6 percent versus 10 percent).

• Median incomes were higher in zip codes where multiple listers lived: $93,081 versus $67,690 for people on just one list.

• Kidneys are the greatest need: one person is listed at eight transplant centers, two people are listed at seven, four are listed at six, and 18 are on five lists.

The International Society for Heart & Lung Transplantation and the Heart Failure Society of America funded the study.


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