Medicare Patients, Women, Blacks Not Likely to be
Even Evaluated for Liver Transplants
62% of patients with commercial insurance were
evaluated compared to 4.7% with Medicare only
Aug. 31, 2009 Older Americans depending on
Medicare for medical insurance are far less likely to be considered for
a liver transplant that people with private insurance. Others obviously
discriminated against in this process or women and black people,
according to a study from the University of Pittsburg School of
Medicine.
The study in the September issue of the American
Journal of Transplantation, indicates that women, blacks and
patients with Medicare who are in end-stage liver disease are less
likely to be referred and evaluated for liver transplantation.
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Disparities were especially apparent in the early
stages of the process when evaluation and listing occurs
● 61 percent of men were evaluated for transplantation compared to 39
percent of women;
● 73.8 percent of whites were evaluated compared to 8.6 percent of
blacks; and
● 62 percent of patients with commercial insurance were evaluated
compared to 4.7 percent with Medicare only.
"There currently is no comprehensive oversight of
liver disease patients as they go through evaluation, referral and are
put on a waitlist for transplantation," said Cindy L. Bryce, Ph.D.,
study lead author and associate professor of medicine, University of
Pittsburgh.
"We know what happens once patients are selected
for transplantation since they are closely monitored, but what happens
prior to this point is fairly invisible. Ours is the first major study
to look at whether everyone with liver-related conditions has a fair
shot of being considered for transplantation, and points out that many
patients are being excluded from this process."
The study, which followed 144,507 patients
hospitalized in Pennsylvania with liver-related conditions, sought to
determine whether any potential barriers exist at the referral and
listing steps in the transplantation process.
Dr. Bryce and colleagues found that 4,361 of these
patients underwent transplant evaluation. Of these, 3,071 were
waitlisted and 1,537 went on to transplantation.
Patients were significantly less likely to undergo
evaluation, wait-listing and eventual transplantation if they were
women, black or covered by Medicare. The researchers did not try to
uncover the reasons for the disparities. Those covered by Medicare, for
example, may have been excluded due to their age, rather than their
insurance source.
"While our study was not designed to identify
causes for these disparities, current practices for identifying and
referring liver disease patients for transplantation should be made more
transparent," said Dr. Bryce.
"Although we face a worsening gap in the supply and
demand for organs for liver transplantation, race, gender and insurance
status should not be factors that preclude patients from being evaluated
for transplantation."
Co-authors of the study include Derek Angus, M.D.,
Robert Arnold, M.D., Chung-Chou Ho Chang, M.D., Max Farrell, B.S., and
Mark S. Roberts, M.D., University of Pittsburgh School of Medicine;
Cosme Manzarbeitia, M.D., and Ignazio Marino, M.D., Thomas Jefferson
University.
The study was funded by the National Institute of
Diabetes and Digestive and Kidney Diseases at the National Institutes of
Health.
