The UNOS committee voted instead to adopt a much weaker plan from George Loss, a doctor at Ochsner Hospital in New Orleans. His proposal, which will be voted on by UNOS’ Board of Directors in early December, calls for shipping organs only when patients are on the verge of death, affecting very few of them and effectively leaving the existing system intact. This plan “all but ensures that where one lives will continue to determine the opportunity for liver transplant for patients with equal need,” said Florman, the transplant surgeon at Mount Sinai. “This is change, but it isn’t really changing anything.”
Angie Compton was a mental health therapy aide in her mid-30s when, about a decade ago, she and her new husband decided to move from Virginia to upstate New York. Around that time, doctors discovered she had Lupus, an autoimmune disease that was damaging her liver. As with Lisa Waters, Angie’s illness progressed slowly. She was able to function normally for a long time, but that changed in 2016. Angie’s doctor told her she needed a transplant. Her friends and family members were tested to see if they could be donors; all came back negative. Since Angie lived in Region 9, where livers are in short supply, her doctor suggested she get listed elsewhere.
At the beginning of 2017, Angie was getting ready to move to Georgia, in the hopes of receiving a transplant from Atlanta’s Emory University Hospital. But the hospital wouldn’t accept her insurance. Like about 20 percent of people on the transplant waiting list in New York, Angie was on her state’s Medicaid, which doesn’t cover organ transplants in other states—and she couldn’t afford to pay out-of-pocket for a transplant in another region. Unable to travel for an available organ, Angie Compton died on January 6 at the age of 43. Multiple studies detail that Compton was far from alone. According to a 2014 study in the journal Clinical Transplantation, “Patients with Medicaid health insurance were significantly more likely to die on the waitlist than those with other insurance,” and “those who received transplants elsewhere had significantly higher incomes than those who died on the waitlist.”
“Celebrity or financial status are not factors in getting a transplant,” UNOS states. Transplant travelers belie this claim. A 2013 study in the journal Transplantationfound that “patients who were able to travel had a 74% increased likelihood of transplantation resulting in a 20% reduction in the risk of death…” The inequities in organ transplants are racial, too: A 2009 study in the American Journal of Transplantation found that Hispanics are less likely than whites to receive transplants, and “these disparities are attributable to geographic differences in organ availability.” A different, 2015 study found that “migrated patients were more likely to be male, of white race … and to have private insurance.” Yet another studydetermined that patients listed at multiple centers tended to be white, older, highly educated, and have private insurance.
Transplant tourism also acts as a perverse incentive for hospitals in relatively organ-rich regions to maintain the status quo, since they benefit from transplanting well-insured, otherwise healthy patients who require less expensive care and survive longer, thereby boosting hospital ratings. Patients with state Medicaid are likelier to have other health problems, dragging down hospital ratings and driving up health costs. “They are clearly selecting people of means,” said Raphael Merriman, a liver specialist at California Pacific Medical Center.
Lisa Waters’s move to North Carolina likely saved her life. She received a successful transplant, and spent four weeks recovering in her Raleigh apartment. “Financially, you have to be able to pay for the stuff that your insurance isn’t going to cover, like renting a place to stay, all your food, all that,” she told me. Now back in New Jersey, she spends nearly $40,000 annually on insurance and takes dozens of pills a day, but feels great. “It was so easy for me,” she said. “For so many people, they just don’t have the option…. The reality is a lot of people just don’t end up getting an organ.”
Article Appeared @https://newrepublic.com/article/145682/gross-inequality-organ-transplants-america