Race, Sex and Insurance are Factors in Liver Transplants

A recent study published by researchers at the University of Pittsburgh finds disparities in the liver transplant system by gender, race, and type of insurance. The retrospective stud looked at the records of 144,507 patients who were admitted to Pennsylvania hospitals for a liver related diagnosis between 1994 and 2001. The study found that overall 3% were evaluated at a transplant center, which is the first step toward getting a liver transplant. Among males 3.4% were evaluated while only 2.6% of females were evaluated. The disparity is even large for “whites” and “blacks” where the evaluation rate for whites was 3.0% and 1.9% for blacks. The impact by insurance finds those who have commercial insurance were evaluated 5.2% of the time, Medicare users were evaluated 3.1% of the time and Medicaid users were evaluated just 1.4% of the time. Lead author Cindy Bryce, Ph.D., says even when issues such as type of liver ailment were factored out of the equation the disparities were still apparent. She says she thinks several factors go into making the disparities. The gaps begin to lessen as patients move from being evaluated to being listed for transplant and on to actually receiving transplanted livers. Bryce says doctors could be making fewer referrals for one set of patients than for another, there could be barriers for patients to get to the transplant centers from remote hospitals, there could be other financial limitations and there could be some cultural differences at play. Bryce says she would like to be able to do a study of the patients as they move through the system to better understand some of the aspects not related to actual referrals but she says it is very difficult to track the patients in “real time.” She says this study has “opened the box” and now the disparities can be further studied and new policies, practices and programs can be put in place to help close the gap. Bryce warns though that this could result in more demand for the already limited number of organs available for transplant.